{"hospital_name":"Adventhealth Murray","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Adventhealth Murray"],"hospital_address":["707 Old Dalton Ellijay Road, Po Box 1406, Chatsworth, GA 30705"],"license_information":{"license_number":"105-706","state":"GA"},"type_2_npi":["1750776571"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Tim Reiner "},"modifier_information":[{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"AdventHealth Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliant Health Plans","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"CareSource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Individual Plan HMO Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Private Healthcare Systems","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Government Optum VA CCN","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","description":"The modified price is presented in the standard 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DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"48433021940","type":"NDC"}],"standard_charges":[{"gross_charge":116.86,"discounted_cash":116.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"FERROUS SULFATE 300 (60 FE) MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"50268033624","type":"NDC"}],"standard_charges":[{"gross_charge":111.12,"discounted_cash":111.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"SENNA 8.8 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"39328012050","type":"NDC"}],"standard_charges":[{"gross_charge":101.55,"discounted_cash":101.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE VISCOUS HCL 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121495040","type":"NDC"}],"standard_charges":[{"gross_charge":73.45,"discounted_cash":73.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"METHADONE HCL 5 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68094003162","type":"NDC"}],"standard_charges":[{"gross_charge":162.19,"discounted_cash":162.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LEVETIRACETAM 100 MG/ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69339015717","type":"NDC"}],"standard_charges":[{"gross_charge":102.99,"discounted_cash":102.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"FERROUS SULFATE 300 (60 FE) MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"39328015705","type":"NDC"}],"standard_charges":[{"gross_charge":131.41,"discounted_cash":131.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LEVALBUTEROL HCL 1.25 MG/3ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"76204090001","type":"NDC"}],"standard_charges":[{"gross_charge":50.66,"discounted_cash":50.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"ALBUTEROL SULFATE 1.25 MG/3ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487990425","type":"NDC"}],"standard_charges":[{"gross_charge":42.73,"discounted_cash":42.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"MEGESTROL ACETATE 40 MG/ML PO SUSP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68094006362","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":24.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FORMOTEROL FUMARATE 20 MCG/2ML IN 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(RACEPINEPHRINE) 4-0.05-0.5 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70092165844","type":"NDC"}],"standard_charges":[{"gross_charge":250.25,"discounted_cash":250.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"DONNATAL 16.2 MG/5ML PO ELIX","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"66689006310","type":"NDC"}],"standard_charges":[{"gross_charge":799.24,"discounted_cash":799.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"IBUPROFEN CHILDRENS 100 MG/5ML PO 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DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"42192060840","type":"NDC"}],"standard_charges":[{"gross_charge":42.77,"discounted_cash":42.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FERROUS SULFATE 300 (60 FE) MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121053005","type":"NDC"}],"standard_charges":[{"gross_charge":76.75,"discounted_cash":76.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.667 ML"}]},{"description":"SODIUM CHLORIDE 7 % IN 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NDC EA = 15 ML"}]},{"description":"NITROGLYCERIN 0.4 MG/SPRAY TL SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802021001","type":"NDC"}],"standard_charges":[{"gross_charge":2936.82,"discounted_cash":2936.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.9 GR"}]},{"description":"NYSTATIN 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69315030660","type":"NDC"}],"standard_charges":[{"gross_charge":927.51,"discounted_cash":927.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 GR"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP 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Charge Type: Pharmacy | NDC EA = 28 GR"}]},{"description":"HYDROCORTISONE 1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802027603","type":"NDC"}],"standard_charges":[{"gross_charge":65.22,"discounted_cash":65.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 GR"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672128202","type":"NDC"}],"standard_charges":[{"gross_charge":120.88,"discounted_cash":120.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"MUPIROCIN 2 % EX 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Charge Type: Pharmacy | NDC EA = 142 GR"}]},{"description":"7 DAY VAGINAL 2 % VA CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672203506","type":"NDC"}],"standard_charges":[{"gross_charge":144.83,"discounted_cash":144.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 GR"}]},{"description":"NITRO-BID 2 % TD OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00281032608","type":"NDC"}],"standard_charges":[{"gross_charge":93.6,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 GR"}]},{"description":"DESITIN DAILY DEFENSE 13 % EX 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Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536118365","type":"NDC"}],"standard_charges":[{"gross_charge":216.68,"discounted_cash":216.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15.8 GR"}]},{"description":"GENTAMICIN SULFATE 0.1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00713068215","type":"NDC"}],"standard_charges":[{"gross_charge":219.68,"discounted_cash":219.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"BACITRACIN-POLYMYXIN B 500-10000 UNIT/GM OP 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Charge Type: Pharmacy | NDC EA = 28 GR"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672201301","type":"NDC"}],"standard_charges":[{"gross_charge":87.84,"discounted_cash":87.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.2 GR"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672302009","type":"NDC"}],"standard_charges":[{"gross_charge":203.21,"discounted_cash":203.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35.44 GR"}]},{"description":"LIDOCAINE 5 % EX 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Charge Type: Pharmacy | NDC EA = 25 GR"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"67877047379","type":"NDC"}],"standard_charges":[{"gross_charge":245.92,"discounted_cash":245.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35.44 GR"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00574402450","type":"NDC"}],"standard_charges":[{"gross_charge":272.02,"discounted_cash":272.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 GR"}]},{"description":"NITROGLYCERIN 0.4 MG/SPRAY TL 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Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00378827052","type":"NDC"}],"standard_charges":[{"gross_charge":12.1,"discounted_cash":12.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"LIDOCAINE VISCOUS HCL 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"gross_charge":17.52,"discounted_cash":17.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.333 ML"}]},{"description":"FLEET PEDIATRIC RECTAL 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Type: Pharmacy | NDC EA = 20 GR"}]},{"description":"SALINE NASAL SPRAY 0.65 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802035758","type":"NDC"}],"standard_charges":[{"gross_charge":36.94,"discounted_cash":36.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"DEXAMETHASONE INTENSOL 1 MG/ML PO CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054317644","type":"NDC"}],"standard_charges":[{"gross_charge":109.59,"discounted_cash":109.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"XALATAN 0.005 % OP 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11089.72,"maximum":21979.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":19342.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11311.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17812.0},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":16634.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11422.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11089.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11089.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":21979.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":16634.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":11089.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11150.82,"10th_percentile":11150.82,"90th_percentile":11158.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8163.07,"maximum":16179.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Employee","methodology":"fee schedule","standard_charge_dollar":12506.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8326.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11517.1},{"payer_name":"Alliant Health Plans","plan_name":"Solocare Exchange","methodology":"fee schedule","standard_charge_dollar":12244.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8407.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8163.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8163.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"fee schedule","standard_charge_dollar":16179.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"fee schedule","standard_charge_dollar":12244.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Government Optum Va Ccn","methodology":"fee schedule","standard_charge_dollar":8163.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8087.67,"10th_percentile":8087.67,"90th_percentile":8087.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed 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0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed 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[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health 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[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health 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[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total 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Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed 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[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health 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Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed 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[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O Cc/Mcc","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health 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Cc/Mcc","code_information":[{"code":"131","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed 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[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health 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Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed 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period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed 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Valid","code_information":[{"code":"214","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed 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[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","code_information":[{"code":"222","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health 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100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","code_information":[{"code":"226","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health 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charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","code_information":[{"code":"227","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed 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[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health 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MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed 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[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health 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at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health 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With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed 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[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed 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[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Cc","code_information":[{"code":"339","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health 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System O.R. 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[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, female reproductive system w CC","code_information":[{"code":"366","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health 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Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed 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[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health 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Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed 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[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health 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w CC","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed 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[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning & toxic Effects of Drugs Age >17 w CC","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health 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CC","code_information":[{"code":"452","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed 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[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health 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With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed 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Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback 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CC","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed 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[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient ischemia","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed 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[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures w/o CC","code_information":[{"code":"530","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health 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charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w CC","code_information":[{"code":"531","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w/o CC","code_information":[{"code":"532","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":69.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","code_information":[{"code":"567","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 112455 | Total % of Charge: 43.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Rehab-Per Diem: 2987] [IP Prosthetics/Implants/Devices (%BC): 0 Charge Threshold 6335 (%BC): 16.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed 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[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","code_information":[{"code":"568","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"1 through 10","median_amount":5329.89,"10th_percentile":5329.89,"90th_percentile":5329.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":717.25,"10th_percentile":717.25,"90th_percentile":717.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":115.95,"10th_percentile":115.95,"90th_percentile":115.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":55.94,"10th_percentile":55.94,"90th_percentile":55.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":53.18,"10th_percentile":53.18,"90th_percentile":53.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"1 through 10","median_amount":338.5,"10th_percentile":338.5,"90th_percentile":338.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":80.84,"10th_percentile":80.84,"90th_percentile":80.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":121.26,"10th_percentile":121.26,"90th_percentile":121.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":67.14,"10th_percentile":67.14,"90th_percentile":67.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"1 through 10","median_amount":168.33,"10th_percentile":168.33,"90th_percentile":168.33}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":1175.1,"10th_percentile":1175.1,"90th_percentile":1175.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"1 through 10","median_amount":147.54,"10th_percentile":147.54,"90th_percentile":151.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"1 through 10","median_amount":784.0,"10th_percentile":784.0,"90th_percentile":784.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"22","median_amount":64.63,"10th_percentile":64.63,"90th_percentile":64.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"1 through 10","median_amount":571.41,"10th_percentile":145.4,"90th_percentile":1413.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"1 through 10","median_amount":144.69,"10th_percentile":144.69,"90th_percentile":144.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"13","median_amount":67.87,"10th_percentile":67.87,"90th_percentile":82.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"11","median_amount":431.99,"10th_percentile":431.99,"90th_percentile":491.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":144.69,"10th_percentile":144.69,"90th_percentile":144.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"1 through 10","median_amount":278.44,"10th_percentile":278.44,"90th_percentile":278.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":218.1,"10th_percentile":218.1,"90th_percentile":218.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"17","median_amount":67.14,"10th_percentile":64.64,"90th_percentile":67.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"1 through 10","median_amount":408.27,"10th_percentile":408.27,"90th_percentile":408.27}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":1429.76,"10th_percentile":958.39,"90th_percentile":2285.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"12","median_amount":256.32,"10th_percentile":256.32,"90th_percentile":256.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"1 through 10","median_amount":1306.0,"10th_percentile":381.35,"90th_percentile":1622.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"104","median_amount":221.69,"10th_percentile":111.05,"90th_percentile":287.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"14","median_amount":1463.43,"10th_percentile":396.86,"90th_percentile":3054.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"1 through 10","median_amount":251.35,"10th_percentile":251.35,"90th_percentile":251.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"82","median_amount":147.08,"10th_percentile":82.23,"90th_percentile":283.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"28","median_amount":1093.49,"10th_percentile":936.23,"90th_percentile":1441.05},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":251.35,"10th_percentile":144.69,"90th_percentile":251.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"1 through 10","median_amount":641.66,"10th_percentile":486.85,"90th_percentile":759.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"45","median_amount":381.35,"10th_percentile":381.35,"90th_percentile":595.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"98","median_amount":67.14,"10th_percentile":67.14,"90th_percentile":164.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"1 through 10","median_amount":949.29,"10th_percentile":781.51,"90th_percentile":1294.52}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":4536.53,"10th_percentile":2997.15,"90th_percentile":7474.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"39","median_amount":586.38,"10th_percentile":393.01,"90th_percentile":834.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"21","median_amount":1337.54,"10th_percentile":732.92,"90th_percentile":1827.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"47","median_amount":401.37,"10th_percentile":245.31,"90th_percentile":671.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"46","median_amount":2799.6,"10th_percentile":623.84,"90th_percentile":4207.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"1 through 10","median_amount":793.96,"10th_percentile":793.96,"90th_percentile":793.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"35","median_amount":406.01,"10th_percentile":220.21,"90th_percentile":594.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"61","median_amount":2004.94,"10th_percentile":1156.36,"90th_percentile":5132.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"56","median_amount":482.44,"10th_percentile":252.54,"90th_percentile":875.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"27","median_amount":1024.17,"10th_percentile":748.71,"90th_percentile":1788.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"85","median_amount":714.26,"10th_percentile":382.27,"90th_percentile":1277.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"48","median_amount":67.14,"10th_percentile":66.78,"90th_percentile":492.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"11","median_amount":2834.46,"10th_percentile":1661.46,"90th_percentile":5902.21}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":6646.18,"10th_percentile":5314.66,"90th_percentile":10155.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"37","median_amount":881.43,"10th_percentile":643.51,"90th_percentile":1508.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"27","median_amount":1860.93,"10th_percentile":1255.82,"90th_percentile":3551.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"25","median_amount":936.25,"10th_percentile":455.79,"90th_percentile":1727.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"52","median_amount":5535.1,"10th_percentile":1198.24,"90th_percentile":8796.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"1 through 10","median_amount":2404.18,"10th_percentile":2042.76,"90th_percentile":3503.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"29","median_amount":948.67,"10th_percentile":515.77,"90th_percentile":1659.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"45","median_amount":7129.71,"10th_percentile":3158.95,"90th_percentile":11498.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"108","median_amount":979.58,"10th_percentile":520.15,"90th_percentile":2386.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"21","median_amount":2199.46,"10th_percentile":1505.94,"90th_percentile":2885.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"79","median_amount":1363.22,"10th_percentile":820.76,"90th_percentile":3670.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"32","median_amount":67.14,"10th_percentile":66.78,"90th_percentile":726.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"14","median_amount":4747.16,"10th_percentile":3108.56,"90th_percentile":9001.98}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"1 through 10","median_amount":183.11,"10th_percentile":183.11,"90th_percentile":183.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":182.44,"10th_percentile":182.44,"90th_percentile":182.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":273.66,"10th_percentile":273.66,"90th_percentile":273.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":6408.57,"10th_percentile":5195.63,"90th_percentile":7621.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"1 through 10","median_amount":368.18,"10th_percentile":368.18,"90th_percentile":368.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":360.39,"10th_percentile":360.29,"90th_percentile":360.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":550.25,"10th_percentile":550.25,"90th_percentile":550.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":124.3,"10th_percentile":124.3,"90th_percentile":124.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"1 through 10","median_amount":2940.44,"10th_percentile":2940.44,"90th_percentile":2940.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":802.14,"10th_percentile":802.14,"90th_percentile":802.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"1 through 10","median_amount":25333.47,"10th_percentile":25333.47,"90th_percentile":25333.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"1 through 10","median_amount":2637.49,"10th_percentile":2637.49,"90th_percentile":2637.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"1 through 10","median_amount":27256.99,"10th_percentile":27256.99,"90th_percentile":27256.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"1 through 10","median_amount":22555.81,"10th_percentile":22555.81,"90th_percentile":22555.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"1 through 10","median_amount":145.42,"10th_percentile":145.42,"90th_percentile":145.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"1 through 10","median_amount":1590.31,"10th_percentile":1590.31,"90th_percentile":1590.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 ENT Procedures","code_information":[{"code":"5164","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"1 through 10","median_amount":11040.3,"10th_percentile":11040.3,"90th_percentile":11040.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"1 through 10","median_amount":5702.22,"10th_percentile":5702.22,"90th_percentile":5702.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5.9,"10th_percentile":5.9,"90th_percentile":5.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 ENT Procedures","code_information":[{"code":"5165","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15969.39,"10th_percentile":15969.39,"90th_percentile":15969.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1399.98,"10th_percentile":1399.98,"90th_percentile":1399.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"1 through 10","median_amount":2888.76,"10th_percentile":2888.76,"90th_percentile":2888.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"1 through 10","median_amount":12733.33,"10th_percentile":12733.33,"90th_percentile":12733.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4334.87,"10th_percentile":4334.87,"90th_percentile":4334.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2224.89,"10th_percentile":2224.89,"90th_percentile":2224.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":1922.29,"10th_percentile":1922.29,"90th_percentile":2570.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"1 through 10","median_amount":1278.87,"10th_percentile":1278.87,"90th_percentile":1278.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"1 through 10","median_amount":1291.25,"10th_percentile":1291.25,"90th_percentile":1919.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1091.24,"10th_percentile":1091.24,"90th_percentile":1091.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"1 through 10","median_amount":11891.89,"10th_percentile":11891.89,"90th_percentile":11891.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"1 through 10","median_amount":9259.33,"10th_percentile":9259.33,"90th_percentile":9259.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":852.61,"10th_percentile":852.61,"90th_percentile":1253.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"1 through 10","median_amount":1648.49,"10th_percentile":1648.49,"90th_percentile":1648.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1919.08,"10th_percentile":1919.08,"90th_percentile":1924.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":1640.78,"10th_percentile":1640.78,"90th_percentile":1640.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"1 through 10","median_amount":7245.13,"10th_percentile":6832.16,"90th_percentile":8027.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"1 through 10","median_amount":5343.82,"10th_percentile":5343.82,"90th_percentile":5343.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1148.2,"10th_percentile":1148.2,"90th_percentile":1148.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1255.65,"10th_percentile":1255.65,"90th_percentile":1255.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":736.55,"10th_percentile":736.55,"90th_percentile":736.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"1 through 10","median_amount":6548.18,"10th_percentile":6548.18,"90th_percentile":6548.18}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":1581.49,"10th_percentile":1581.49,"90th_percentile":1581.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"1 through 10","median_amount":1512.4,"10th_percentile":1512.4,"90th_percentile":1512.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"1 through 10","median_amount":7650.84,"10th_percentile":6934.07,"90th_percentile":10565.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1060.93,"10th_percentile":1060.93,"90th_percentile":1482.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1623.87,"10th_percentile":1623.87,"90th_percentile":2435.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":4702.01,"10th_percentile":4702.01,"90th_percentile":4702.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"1 through 10","median_amount":10259.0,"10th_percentile":10259.0,"90th_percentile":10259.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8035.32,"10th_percentile":8035.32,"90th_percentile":8035.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"1 through 10","median_amount":1799.56,"10th_percentile":1799.56,"90th_percentile":1799.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"1 through 10","median_amount":6762.61,"10th_percentile":6762.61,"90th_percentile":6762.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2689.89,"10th_percentile":2689.89,"90th_percentile":2689.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":1469.29,"10th_percentile":1469.29,"90th_percentile":1469.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"1 through 10","median_amount":5846.78,"10th_percentile":5846.78,"90th_percentile":6809.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"1 through 10","median_amount":634.35,"10th_percentile":634.35,"90th_percentile":634.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"1 through 10","median_amount":1851.94,"10th_percentile":1851.94,"90th_percentile":1851.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":632.12,"10th_percentile":632.12,"90th_percentile":632.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":953.76,"10th_percentile":953.76,"90th_percentile":953.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":210.1,"10th_percentile":210.1,"90th_percentile":210.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":579.14,"10th_percentile":579.14,"90th_percentile":579.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"1 through 10","median_amount":1230.65,"10th_percentile":1230.65,"90th_percentile":1230.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"1 through 10","median_amount":1703.03,"10th_percentile":1703.03,"90th_percentile":1853.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"1 through 10","median_amount":5503.72,"10th_percentile":5503.72,"90th_percentile":5503.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"1 through 10","median_amount":6746.71,"10th_percentile":6746.71,"90th_percentile":6746.71},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":819.41,"10th_percentile":813.72,"90th_percentile":1210.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"1 through 10","median_amount":2348.06,"10th_percentile":2348.06,"90th_percentile":2348.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1839.23,"10th_percentile":1839.23,"90th_percentile":1839.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"1 through 10","median_amount":5813.4,"10th_percentile":5813.4,"90th_percentile":5813.4}]}]},{"description":"Level 1 Intraocular Procedures","code_information":[{"code":"5491","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"1 through 10","median_amount":2101.78,"10th_percentile":2101.78,"90th_percentile":2101.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"1 through 10","median_amount":14847.2,"10th_percentile":14335.83,"90th_percentile":25125.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"1 through 10","median_amount":2054.1,"10th_percentile":2054.1,"90th_percentile":2054.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"1 through 10","median_amount":14118.2,"10th_percentile":14118.2,"90th_percentile":14118.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2061.2,"10th_percentile":2061.2,"90th_percentile":2061.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3141.12,"10th_percentile":3141.12,"90th_percentile":3556.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Intraocular Procedures","code_information":[{"code":"5493","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4661.64,"10th_percentile":4651.69,"90th_percentile":4661.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":46.15,"10th_percentile":46.15,"90th_percentile":46.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"11","median_amount":81.51,"10th_percentile":81.14,"90th_percentile":156.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"1 through 10","median_amount":121.26,"10th_percentile":121.26,"90th_percentile":234.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":34.77,"10th_percentile":24.95,"90th_percentile":64.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"13","median_amount":412.54,"10th_percentile":225.61,"90th_percentile":1201.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"1 through 10","median_amount":79.22,"10th_percentile":79.22,"90th_percentile":155.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":76.41,"10th_percentile":76.41,"90th_percentile":76.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"11","median_amount":257.94,"10th_percentile":138.28,"90th_percentile":738.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":80.84,"10th_percentile":79.55,"90th_percentile":166.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"1 through 10","median_amount":154.81,"10th_percentile":154.81,"90th_percentile":154.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"32","median_amount":121.26,"10th_percentile":121.26,"90th_percentile":265.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":35.08,"10th_percentile":24.95,"90th_percentile":72.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"1 through 10","median_amount":60.24,"10th_percentile":60.24,"90th_percentile":60.24}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":160.85,"10th_percentile":130.38,"90th_percentile":242.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"14","median_amount":98.0,"10th_percentile":97.6,"90th_percentile":99.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"1 through 10","median_amount":146.46,"10th_percentile":146.46,"90th_percentile":146.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":61.08,"10th_percentile":49.47,"90th_percentile":104.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"18","median_amount":844.42,"10th_percentile":437.38,"90th_percentile":1594.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"1 through 10","median_amount":95.69,"10th_percentile":95.69,"90th_percentile":95.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":109.98,"10th_percentile":99.29,"90th_percentile":154.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"19","median_amount":704.68,"10th_percentile":437.18,"90th_percentile":1420.27},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"49","median_amount":97.64,"10th_percentile":95.69,"90th_percentile":177.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"1 through 10","median_amount":186.98,"10th_percentile":186.98,"90th_percentile":186.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"42","median_amount":146.46,"10th_percentile":146.46,"90th_percentile":146.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":94.58,"10th_percentile":49.48,"90th_percentile":210.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"1 through 10","median_amount":661.68,"10th_percentile":413.18,"90th_percentile":1349.95}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":691.01,"10th_percentile":691.01,"90th_percentile":691.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"1 through 10","median_amount":222.76,"10th_percentile":222.76,"90th_percentile":226.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"1 through 10","median_amount":332.91,"10th_percentile":332.91,"90th_percentile":332.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":337.12,"10th_percentile":337.12,"90th_percentile":674.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"1 through 10","median_amount":1284.95,"10th_percentile":844.42,"90th_percentile":2569.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"1 through 10","median_amount":435.0,"10th_percentile":435.0,"90th_percentile":435.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":475.28,"10th_percentile":475.28,"90th_percentile":475.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"1 through 10","median_amount":3509.24,"10th_percentile":3509.24,"90th_percentile":6180.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":221.94,"10th_percentile":221.94,"90th_percentile":436.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"1 through 10","median_amount":425.02,"10th_percentile":425.02,"90th_percentile":425.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":332.91,"10th_percentile":332.91,"90th_percentile":744.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":231.39,"10th_percentile":231.39,"90th_percentile":452.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"1 through 10","median_amount":1947.85,"10th_percentile":1783.0,"90th_percentile":2979.67}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":686.2,"10th_percentile":686.2,"90th_percentile":686.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"1 through 10","median_amount":505.28,"10th_percentile":505.13,"90th_percentile":506.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"1 through 10","median_amount":755.15,"10th_percentile":755.15,"90th_percentile":755.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":379.41,"10th_percentile":379.41,"90th_percentile":379.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"1 through 10","median_amount":3354.43,"10th_percentile":3354.43,"90th_percentile":4421.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"1 through 10","median_amount":493.36,"10th_percentile":493.36,"90th_percentile":493.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":978.16,"10th_percentile":978.16,"90th_percentile":978.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":495.96,"10th_percentile":495.96,"90th_percentile":503.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":755.15,"10th_percentile":755.15,"90th_percentile":755.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"1 through 10","median_amount":2396.73,"10th_percentile":2396.73,"90th_percentile":2396.73}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"1 through 10","median_amount":400.98,"10th_percentile":400.98,"90th_percentile":400.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"1 through 10","median_amount":245.18,"10th_percentile":245.18,"90th_percentile":245.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"1 through 10","median_amount":922.96,"10th_percentile":922.96,"90th_percentile":2214.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"1 through 10","median_amount":591.42,"10th_percentile":591.42,"90th_percentile":591.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":163.45,"10th_percentile":163.45,"90th_percentile":398.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"1 through 10","median_amount":313.01,"10th_percentile":313.01,"90th_percentile":313.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":245.18,"10th_percentile":245.18,"90th_percentile":245.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"1 through 10","median_amount":333.77,"10th_percentile":329.11,"90th_percentile":333.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"1 through 10","median_amount":491.85,"10th_percentile":491.85,"90th_percentile":491.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":655.35,"10th_percentile":655.35,"90th_percentile":655.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"1 through 10","median_amount":1350.67,"10th_percentile":947.55,"90th_percentile":1388.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":655.74,"10th_percentile":655.74,"90th_percentile":655.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"1 through 10","median_amount":4006.78,"10th_percentile":3585.09,"90th_percentile":4028.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":327.84,"10th_percentile":327.84,"90th_percentile":327.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":491.85,"10th_percentile":491.85,"90th_percentile":491.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"1 through 10","median_amount":3713.11,"10th_percentile":3713.11,"90th_percentile":3713.11}]}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"1 through 10","median_amount":1088.1,"10th_percentile":1088.1,"90th_percentile":1088.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"1 through 10","median_amount":710.89,"10th_percentile":710.89,"90th_percentile":710.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"1 through 10","median_amount":3342.38,"10th_percentile":3342.38,"90th_percentile":3342.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":713.49,"10th_percentile":713.49,"90th_percentile":1111.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1088.1,"10th_percentile":1088.1,"90th_percentile":1088.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":741.33,"10th_percentile":741.33,"90th_percentile":741.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"1 through 10","median_amount":1708.33,"10th_percentile":1708.33,"90th_percentile":1708.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"1 through 10","median_amount":2676.42,"10th_percentile":2676.42,"90th_percentile":2676.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"1 through 10","median_amount":13702.22,"10th_percentile":13702.22,"90th_percentile":13702.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1680.45,"10th_percentile":1181.17,"90th_percentile":2712.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1797.96,"10th_percentile":1797.96,"90th_percentile":1797.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"1 through 10","median_amount":8740.35,"10th_percentile":8740.35,"90th_percentile":8740.35}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":412.54,"10th_percentile":412.54,"90th_percentile":412.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"1 through 10","median_amount":194.16,"10th_percentile":194.16,"90th_percentile":194.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"1 through 10","median_amount":1893.1,"10th_percentile":1893.1,"90th_percentile":1893.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":182.42,"10th_percentile":182.42,"90th_percentile":182.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"1 through 10","median_amount":1524.61,"10th_percentile":1491.83,"90th_percentile":1524.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":190.35,"10th_percentile":190.35,"90th_percentile":190.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":290.18,"10th_percentile":290.18,"90th_percentile":290.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"1 through 10","median_amount":1409.92,"10th_percentile":1409.92,"90th_percentile":1440.9}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"1 through 10","median_amount":2069.45,"10th_percentile":2069.45,"90th_percentile":2069.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3596.19,"10th_percentile":3596.19,"90th_percentile":3596.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"1 through 10","median_amount":1834.06,"10th_percentile":1834.06,"90th_percentile":1834.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1603.42,"10th_percentile":1603.42,"90th_percentile":1603.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":114.22,"10th_percentile":114.22,"90th_percentile":164.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"1 through 10","median_amount":55.44,"10th_percentile":54.74,"90th_percentile":55.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"1 through 10","median_amount":81.81,"10th_percentile":81.81,"90th_percentile":81.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":89.6,"10th_percentile":89.6,"90th_percentile":89.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"1 through 10","median_amount":886.12,"10th_percentile":558.37,"90th_percentile":1239.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":121.58,"10th_percentile":121.58,"90th_percentile":121.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"1 through 10","median_amount":733.19,"10th_percentile":733.19,"90th_percentile":751.51},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":54.54,"10th_percentile":54.54,"90th_percentile":54.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":81.81,"10th_percentile":81.81,"90th_percentile":81.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"1 through 10","median_amount":118.79,"10th_percentile":118.79,"90th_percentile":118.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":116.46,"10th_percentile":116.46,"90th_percentile":116.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":717.25,"10th_percentile":717.25,"90th_percentile":717.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"17","median_amount":157.28,"10th_percentile":76.29,"90th_percentile":375.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"1 through 10","median_amount":24.06,"10th_percentile":17.93,"90th_percentile":68.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"1 through 10","median_amount":52.64,"10th_percentile":52.64,"90th_percentile":52.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":14.14,"10th_percentile":11.5,"90th_percentile":123.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"1 through 10","median_amount":548.47,"10th_percentile":548.47,"90th_percentile":548.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"1 through 10","median_amount":27.74,"10th_percentile":25.47,"90th_percentile":276.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":16.22,"10th_percentile":9.77,"90th_percentile":98.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"1 through 10","median_amount":269.23,"10th_percentile":166.87,"90th_percentile":1235.19},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":25.32,"10th_percentile":11.02,"90th_percentile":60.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"1 through 10","median_amount":53.69,"10th_percentile":53.69,"90th_percentile":82.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":36.04,"10th_percentile":25.9,"90th_percentile":222.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":25.8,"10th_percentile":5.53,"90th_percentile":103.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"1 through 10","median_amount":299.14,"10th_percentile":157.71,"90th_percentile":1889.22}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 5063] [Cardiac Cath ($): 6990] [Lithotripsy ($): 8064] [PTCA ($): 10751] [Observation (%BC): 50.2] [Observation ($): 2690] [ED Level 1--99281 ($): 606] [ED Level 2--99282 ($): 808] [ED Level 3--99283 ($): 1345] [ED Level 4--99284 ($): 1882] [ED Level 5--99285 ($): 2354] [Radiation Therapy ($): 2354] [CT Scan OP ($): 1304] [MRI OP ($): 1628] [Mammography-Diagnostic ($): 124] [Mammography-Screening ($): 418] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Other Outpatient Implant (%BC): 0 Charge Threshold 6525 (%BC): 16.2] [All Other OP (%BC): 50.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":68.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE] [All Other OP (%BC): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":431.97,"10th_percentile":431.97,"90th_percentile":431.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":51.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Plan Hmo Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Ambetter Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":48.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.6,"count":"1 through 10","median_amount":65.18,"10th_percentile":65.18,"90th_percentile":65.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 13.5]","count":"15","median_amount":99.7,"10th_percentile":99.7,"90th_percentile":99.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant Health Plans","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. 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