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It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities"}]},{"description":"CHEST 1 VIEW (FRONTAL) RADIOLOGIC EXAM","code_information":[{"code":"60795143","type":"CDM"},{"code":"320","type":"RC"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":123.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"RIBS UNILATERAL AND CHEST PA RADIOLOGIC EXAM","code_information":[{"code":"60795218","type":"CDM"},{"code":"320","type":"RC"},{"code":"71101","type":"HCPCS"}],"standard_charges":[{"gross_charge":519.0,"discounted_cash":311.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"RIBS BILATERAL WITH PA CHEST RADIOLOGIC EXAM","code_information":[{"code":"60795226","type":"CDM"},{"code":"320","type":"RC"},{"code":"71111","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.0,"discounted_cash":383.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"STERNUM RADIOLOGIC EXAM","code_information":[{"code":"60795234","type":"CDM"},{"code":"320","type":"RC"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":150.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"STERNOCLAVICULAR JOINTS RADIOLOGIC EXAM","code_information":[{"code":"60795242","type":"CDM"},{"code":"320","type":"RC"},{"code":"71130","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":184.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"ABDOMEN - 1 VIEW RADIOLOGIC EXAM","code_information":[{"code":"60795259","type":"CDM"},{"code":"320","type":"RC"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"ABDOMEN - 2 VWS ONLY FLAT & ERECT RADIOLOGIC EXAM","code_information":[{"code":"60795267","type":"CDM"},{"code":"320","type":"RC"},{"code":"74019","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":207.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"ABDOMEN-3VIEWS RADIOLOGIC EXAM","code_information":[{"code":"60795275","type":"CDM"},{"code":"320","type":"RC"},{"code":"74022","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":207.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"SINGLE VIEW FOREIGN BODY CHILD RADIOLOGIC EXAM","code_information":[{"code":"60795283","type":"CDM"},{"code":"320","type":"RC"},{"code":"76010","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":51.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"ENTIRE SPINE AP AND LATERAL RADIOLOGIC EXAM","code_information":[{"code":"60795291","type":"CDM"},{"code":"320","type":"RC"},{"code":"72082","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":216.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CERVICAL SPINE AP AND LATERAL RADIOLOGIC EXAM","code_information":[{"code":"60795309","type":"CDM"},{"code":"320","type":"RC"},{"code":"72040","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":310.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"C-SPINE AP LAB OBLIQUES RADIOLOGIC EXAM","code_information":[{"code":"60795317","type":"CDM"},{"code":"320","type":"RC"},{"code":"72050","type":"HCPCS"}],"standard_charges":[{"gross_charge":704.0,"discounted_cash":422.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"C-SPINE COMP W/FLEX EXTENSION RADIOLOGIC EXAM","code_information":[{"code":"60795325","type":"CDM"},{"code":"320","type":"RC"},{"code":"72052","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.0,"discounted_cash":521.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"T-SPINE AP AND LATERAL RADIOLOGIC EXAM","code_information":[{"code":"60795333","type":"CDM"},{"code":"320","type":"RC"},{"code":"72070","type":"HCPCS"}],"standard_charges":[{"gross_charge":594.0,"discounted_cash":356.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"THORACO-LUMBAR RADIOLOGIC EXAM","code_information":[{"code":"60795358","type":"CDM"},{"code":"320","type":"RC"},{"code":"72080","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":111.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"LUMBAR SPINE AP LATERAL RADIOLOGIC EXAM","code_information":[{"code":"60795374","type":"CDM"},{"code":"320","type":"RC"},{"code":"72100","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":360.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"LUMBAR SPINE  COMPLETE RADIOLOGIC EXAM","code_information":[{"code":"60795382","type":"CDM"},{"code":"320","type":"RC"},{"code":"72110","type":"HCPCS"}],"standard_charges":[{"gross_charge":832.0,"discounted_cash":499.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"LUMBAR SPINE COMPLETE MIN 6 VIEWS RADIOLOGIC EXAM","code_information":[{"code":"60795390","type":"CDM"},{"code":"320","type":"RC"},{"code":"72114","type":"HCPCS"}],"standard_charges":[{"gross_charge":1049.0,"discounted_cash":629.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"PELVIS AP RADIOLOGIC EXAM","code_information":[{"code":"60795416","type":"CDM"},{"code":"320","type":"RC"},{"code":"72170","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":153.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"PELVIS 3 OR MORE VIEWS RADIOLOGIC EXAM","code_information":[{"code":"60795424","type":"CDM"},{"code":"320","type":"RC"},{"code":"72190","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":183.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"SACROILIAC JOINTS COMPLETE RADIOLOGIC EXAM","code_information":[{"code":"60795432","type":"CDM"},{"code":"320","type":"RC"},{"code":"72202","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":235.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"SACRUM COCCYX RADIOLOGIC EXAM","code_information":[{"code":"60795440","type":"CDM"},{"code":"320","type":"RC"},{"code":"72220","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.0,"discounted_cash":233.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CLAVICLE RADIOLOGIC EXAM","code_information":[{"code":"60795457","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":235.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"SCAPULA RADIOLOGIC EXAM","code_information":[{"code":"60795465","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":136.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"SHOULDER 1 VIEW RADIOLOGIC EXAM","code_information":[{"code":"60795473","type":"CDM"},{"code":"320","type":"RC"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":195.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"SHOULDER COMPLETE RADIOLOGIC EXAM","code_information":[{"code":"60795481","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.0,"discounted_cash":249.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"HUMERUS 2 VIEWS RADIOLOGIC EXAM","code_information":[{"code":"60795515","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":171.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"ELBOW AP LATERAL RADIOLOGIC EXAM","code_information":[{"code":"60795523","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":199.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"ELBOW 4 VIEWS RADIOLOGIC EXAM","code_information":[{"code":"60795531","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":231.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"FOREARM AP LAT RADIOLOGIC EXAM","code_information":[{"code":"60795556","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.0,"discounted_cash":217.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"UPPER EXTREMITY INFANT 2V RADIOLOGIC EXAM","code_information":[{"code":"60795564","type":"CDM"},{"code":"320","type":"RC"},{"code":"73092","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":174.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"WRIST AP LATERAL RADIOLOGIC EXAM","code_information":[{"code":"60795572","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"WRIST COMPLETE RADIOLOGIC EXAM","code_information":[{"code":"60795580","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":103.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"HAND AP & LATERAL RADIOLOGIC EXAM","code_information":[{"code":"60795606","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":178.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"FINGER 2 VIEWS RADIOLOGIC EXAM","code_information":[{"code":"60795614","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":213.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"ESOPHOGRAM RADIOLOGIC EXAM","code_information":[{"code":"60795622","type":"CDM"},{"code":"320","type":"RC"},{"code":"74220","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":350.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"UPPER GI RADIOLOGIC EXAM","code_information":[{"code":"60795630","type":"CDM"},{"code":"320","type":"RC"},{"code":"74240","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":273.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"SMALL BOWEL ONLY RADIOLOGIC EXAM","code_information":[{"code":"60795655","type":"CDM"},{"code":"320","type":"RC"},{"code":"74250","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":138.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"BARIUM ENEMA RADIOLOGIC EXAM","code_information":[{"code":"60795663","type":"CDM"},{"code":"320","type":"RC"},{"code":"74270","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.0,"discounted_cash":490.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"BE-AIR CONTRAST RADIOLOGIC EXAM","code_information":[{"code":"60795671","type":"CDM"},{"code":"320","type":"RC"},{"code":"74280","type":"HCPCS"}],"standard_charges":[{"gross_charge":1144.0,"discounted_cash":686.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"T-TUBE CHOLANGRAM RADIOLOGIC EXAM","code_information":[{"code":"60795705","type":"CDM"},{"code":"320","type":"RC"},{"code":"47531","type":"HCPCS"}],"standard_charges":[{"gross_charge":2783.0,"discounted_cash":1669.8,"setting":"both","billing_class":"facility"}]},{"description":"HIP UNILATERAL 2-3 VIEWS RADIOLOGIC EXAM","code_information":[{"code":"60795713","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":142.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"BILATERAL HIPS & PELVIS - 2 VIEWS RADIOLOGIC EXAM","code_information":[{"code":"60795721","type":"CDM"},{"code":"320","type":"RC"},{"code":"73521","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":130.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"KNEE AP LAT ONLY RADIOLOGIC EXAM","code_information":[{"code":"60795762","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":251.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"XR KNEE W/SUNRISE BILATERAL LT AND RT","code_information":[{"code":"60795770","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":481.0,"discounted_cash":288.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"XR KNEE COMPLETE 4 + VIEWS BILATERAL LT AND RT","code_information":[{"code":"60795788","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.0,"discounted_cash":320.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"TIBIA AND FIBULA RADIOLOGIC EXAM","code_information":[{"code":"60795804","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":244.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"ANKLE AP & LATERAL RADIOLOGIC EXAM","code_information":[{"code":"60795820","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":274.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"ANKLE COMPLETE RADIOLOGIC EXAM","code_information":[{"code":"60795838","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.0,"discounted_cash":291.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"FOOT 3 VIEWS AP OBL LATERAL RADIOLOGIC EXAM","code_information":[{"code":"60795853","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.0,"discounted_cash":280.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CALCANEOUS-2VWS RADIOLOGIC EXAM","code_information":[{"code":"60795861","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":204.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"TOES 2 VIEW RADIOLOGIC EXAM","code_information":[{"code":"60795879","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":205.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"IVP WITHOUT TOMOGRAPHY RADIOLOGIC EXAM","code_information":[{"code":"60795895","type":"CDM"},{"code":"320","type":"RC"},{"code":"74400","type":"HCPCS"}],"standard_charges":[{"gross_charge":2220.0,"discounted_cash":1332.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CYSTOGRAM RADIOLOGIC EXAM MIN 3 VIEWS","code_information":[{"code":"60795903","type":"CDM"},{"code":"320","type":"RC"},{"code":"74430","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":168.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"VOID CYSTOGRAM (EXPLDS) RADIOLOGIC EXAM","code_information":[{"code":"60795929","type":"CDM"},{"code":"320","type":"RC"},{"code":"74455","type":"HCPCS"}],"standard_charges":[{"gross_charge":724.0,"discounted_cash":434.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"BONE AGE LT HAND RADIOLOGIC EXAM","code_information":[{"code":"60796059","type":"CDM"},{"code":"320","type":"RC"},{"code":"77072","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":133.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"FEMUR AP & LATERAL RADIOLOGIC EXAM","code_information":[{"code":"60796281","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":99.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"BILATERAL  INFANT LOWER EXTREMITY RADIOLOGIC EXAM","code_information":[{"code":"60796331","type":"CDM"},{"code":"320","type":"RC"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":87.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"BONE SURVEY ROUTINE MYELOMA RADIOLOGIC EXAM","code_information":[{"code":"60796398","type":"CDM"},{"code":"320","type":"RC"},{"code":"77075","type":"HCPCS"}],"standard_charges":[{"gross_charge":803.0,"discounted_cash":481.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MAJOR JOINT OR BURSA INJECTION ASPIRATION AND/OR INJECTION","code_information":[{"code":"60796455","type":"CDM"},{"code":"360","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":247.8,"setting":"both","billing_class":"facility"}]},{"description":"HYSTEROSALPINGOGM (EXPLDS) RADIOLOGIC EXAM","code_information":[{"code":"60796489","type":"CDM"},{"code":"320","type":"RC"},{"code":"74740","type":"HCPCS"}],"standard_charges":[{"gross_charge":1181.0,"discounted_cash":708.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"INJECTION HYSTEROSALPINGOGRAM","code_information":[{"code":"60796497","type":"CDM"},{"code":"360","type":"RC"},{"code":"58340","type":"HCPCS"}],"standard_charges":[{"gross_charge":986.0,"discounted_cash":591.6,"setting":"both","billing_class":"facility"}]},{"description":"OSSEOUS BONE SURVEY INFANT RADIOLOGIC EXAM","code_information":[{"code":"60796596","type":"CDM"},{"code":"320","type":"RC"},{"code":"77076","type":"HCPCS"}],"standard_charges":[{"gross_charge":884.0,"discounted_cash":530.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT HEAD WITHOUT CONTRAST","code_information":[{"code":"60825007","type":"CDM"},{"code":"351","type":"RC"},{"code":"70450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1962.0,"discounted_cash":1177.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT HEAD WITH/WITHOUT CONTRAST","code_information":[{"code":"60825023","type":"CDM"},{"code":"351","type":"RC"},{"code":"70470","type":"HCPCS"}],"standard_charges":[{"gross_charge":3179.0,"discounted_cash":1907.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT ORBITS/SELLA/POSTERIOR","code_information":[{"code":"60825049","type":"CDM"},{"code":"351","type":"RC"},{"code":"70480","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.0,"discounted_cash":496.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT ORBITS PF SELLA TEMP BONE WITH CONTRAST","code_information":[{"code":"60825056","type":"CDM"},{"code":"351","type":"RC"},{"code":"70481","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.0,"discounted_cash":586.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT ORB PF TEMP BONE WITH AND WITHOUT CONTRAST","code_information":[{"code":"60825064","type":"CDM"},{"code":"351","type":"RC"},{"code":"70482","type":"HCPCS"}],"standard_charges":[{"gross_charge":1069.0,"discounted_cash":641.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT MAXILLOFACIAL AREA WITHOUT CONTRAST","code_information":[{"code":"60825072","type":"CDM"},{"code":"351","type":"RC"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1176.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT MAXILOFACIAL AREA W/CONTRAST","code_information":[{"code":"60825080","type":"CDM"},{"code":"351","type":"RC"},{"code":"70487","type":"HCPCS"}],"standard_charges":[{"gross_charge":2352.0,"discounted_cash":1411.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL","code_information":[{"code":"60825098","type":"CDM"},{"code":"351","type":"RC"},{"code":"70488","type":"HCPCS"}],"standard_charges":[{"gross_charge":2882.0,"discounted_cash":1729.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT SOFT TISSUE NECK WITHOUT CONTRAST","code_information":[{"code":"60825114","type":"CDM"},{"code":"351","type":"RC"},{"code":"70490","type":"HCPCS"}],"standard_charges":[{"gross_charge":1762.0,"discounted_cash":1057.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT SOFT TISSUE NECK WITH CONTRAST","code_information":[{"code":"60825122","type":"CDM"},{"code":"351","type":"RC"},{"code":"70491","type":"HCPCS"}],"standard_charges":[{"gross_charge":2148.0,"discounted_cash":1288.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT SOFT TISSUE NECK WITH WITHOUT CONTRAST","code_information":[{"code":"60825130","type":"CDM"},{"code":"351","type":"RC"},{"code":"70492","type":"HCPCS"}],"standard_charges":[{"gross_charge":2535.0,"discounted_cash":1521.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT THORAX WITHOUT CONTRAST","code_information":[{"code":"60825148","type":"CDM"},{"code":"352","type":"RC"},{"code":"71250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1179.0,"discounted_cash":707.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT THORAX WITH CONTRAST","code_information":[{"code":"60825155","type":"CDM"},{"code":"352","type":"RC"},{"code":"71260","type":"HCPCS"}],"standard_charges":[{"gross_charge":2357.0,"discounted_cash":1414.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT THORAX WITH AND WITHOUT CONTRAST","code_information":[{"code":"60825163","type":"CDM"},{"code":"352","type":"RC"},{"code":"71270","type":"HCPCS"}],"standard_charges":[{"gross_charge":2639.0,"discounted_cash":1583.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT CERVICAL SPINE WITHOUT CONTRAST","code_information":[{"code":"60825171","type":"CDM"},{"code":"352","type":"RC"},{"code":"72125","type":"HCPCS"}],"standard_charges":[{"gross_charge":2835.0,"discounted_cash":1701.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT CERVICAL SPINE WITH CONTRAST","code_information":[{"code":"60825189","type":"CDM"},{"code":"352","type":"RC"},{"code":"72126","type":"HCPCS"}],"standard_charges":[{"gross_charge":4083.0,"discounted_cash":2449.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT THORACIC SPINE WITHOUT CONTRAST","code_information":[{"code":"60825205","type":"CDM"},{"code":"352","type":"RC"},{"code":"72128","type":"HCPCS"}],"standard_charges":[{"gross_charge":2696.0,"discounted_cash":1617.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT THORACIC SPINE WITH CONTRAST","code_information":[{"code":"60825213","type":"CDM"},{"code":"352","type":"RC"},{"code":"72129","type":"HCPCS"}],"standard_charges":[{"gross_charge":5391.0,"discounted_cash":3234.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT THORACIC SPINE WITH AND WITHOUT CONTRAST","code_information":[{"code":"60825221","type":"CDM"},{"code":"352","type":"RC"},{"code":"72130","type":"HCPCS"}],"standard_charges":[{"gross_charge":6038.0,"discounted_cash":3622.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT LUMBAR SPINE WITHOUT CONTRAST","code_information":[{"code":"60825239","type":"CDM"},{"code":"352","type":"RC"},{"code":"72131","type":"HCPCS"}],"standard_charges":[{"gross_charge":762.0,"discounted_cash":457.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT LUMBAR SPINE WITH CONTRAST","code_information":[{"code":"60825247","type":"CDM"},{"code":"352","type":"RC"},{"code":"72132","type":"HCPCS"}],"standard_charges":[{"gross_charge":2383.0,"discounted_cash":1429.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT LUMBAR SPINE WITH AND WITHOUT CONTRAST","code_information":[{"code":"60825254","type":"CDM"},{"code":"352","type":"RC"},{"code":"72133","type":"HCPCS"}],"standard_charges":[{"gross_charge":1622.0,"discounted_cash":973.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT PELVIS WITHOUT CONTRAST","code_information":[{"code":"60825262","type":"CDM"},{"code":"352","type":"RC"},{"code":"72192","type":"HCPCS"}],"standard_charges":[{"gross_charge":2540.0,"discounted_cash":1524.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT PELVIS WITH CONTRAST","code_information":[{"code":"60825270","type":"CDM"},{"code":"352","type":"RC"},{"code":"72193","type":"HCPCS"}],"standard_charges":[{"gross_charge":3048.0,"discounted_cash":1828.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT PELVIS WITH AND WITHOUT CONTRAST","code_information":[{"code":"60825288","type":"CDM"},{"code":"352","type":"RC"},{"code":"72194","type":"HCPCS"}],"standard_charges":[{"gross_charge":5690.0,"discounted_cash":3414.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT UPPER EXTREMITY WITHOUT CONTRAST","code_information":[{"code":"60825304","type":"CDM"},{"code":"352","type":"RC"},{"code":"73200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1869.0,"discounted_cash":1121.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT UPPER EXTREMITY WITH CONTRAST","code_information":[{"code":"60825312","type":"CDM"},{"code":"352","type":"RC"},{"code":"73201","type":"HCPCS"}],"standard_charges":[{"gross_charge":2318.0,"discounted_cash":1390.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT LOWER EXTREMITY WITHOUT CONTRAST","code_information":[{"code":"60825338","type":"CDM"},{"code":"352","type":"RC"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1779.0,"discounted_cash":1067.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT LOWER EXTREMITY WITH CONTRAST","code_information":[{"code":"60825346","type":"CDM"},{"code":"352","type":"RC"},{"code":"73701","type":"HCPCS"}],"standard_charges":[{"gross_charge":2242.0,"discounted_cash":1345.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT LOWER EXTREMITY WITH WITHOUT CONTRAST","code_information":[{"code":"60825353","type":"CDM"},{"code":"352","type":"RC"},{"code":"73702","type":"HCPCS"}],"standard_charges":[{"gross_charge":2722.0,"discounted_cash":1633.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT ABDOMEN WITHOUT CONTRAST","code_information":[{"code":"60825361","type":"CDM"},{"code":"352","type":"RC"},{"code":"74150","type":"HCPCS"}],"standard_charges":[{"gross_charge":1929.0,"discounted_cash":1157.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT ABDOMEN WITH CONTRAST","code_information":[{"code":"60825379","type":"CDM"},{"code":"352","type":"RC"},{"code":"74160","type":"HCPCS"}],"standard_charges":[{"gross_charge":2979.0,"discounted_cash":1787.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CT ABDOMEN WITH AND WITHOUT CONTRAST","code_information":[{"code":"60825387","type":"CDM"},{"code":"352","type":"RC"},{"code":"74170","type":"HCPCS"}],"standard_charges":[{"gross_charge":3385.0,"discounted_cash":2031.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"CTA CHEST W/WO CONTRAST","code_information":[{"code":"60825569","type":"CDM"},{"code":"359","type":"RC"},{"code":"71275","type":"HCPCS"}],"standard_charges":[{"gross_charge":4231.0,"discounted_cash":2538.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"NUTR ASSESSMENT","code_information":[{"code":"61410106","type":"CDM"},{"code":"942","type":"RC"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility"}]},{"description":"REHAB NUTR ASSMNT","code_information":[{"code":"61410114","type":"CDM"},{"code":"942","type":"RC"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"both","billing_class":"facility"}]},{"description":"NUTR EVAL F/U LTD","code_information":[{"code":"61410122","type":"CDM"},{"code":"942","type":"RC"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility"}]},{"description":"NUTR EVAL FU COMP","code_information":[{"code":"61410130","type":"CDM"},{"code":"942","type":"RC"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":34.8,"setting":"both","billing_class":"facility"}]},{"description":"INIT NUTRITION","code_information":[{"code":"61430005","type":"CDM"},{"code":"942","type":"RC"},{"code":"97802","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility"}]},{"description":"MRI LOWER EXTREMITY WITHOUT CONTRAST","code_information":[{"code":"61615019","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":2123.0,"discounted_cash":1273.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRI THORACIC SPINE WITHOUT CONTRAST","code_information":[{"code":"61615035","type":"CDM"},{"code":"612","type":"RC"},{"code":"72146","type":"HCPCS"}],"standard_charges":[{"gross_charge":2686.0,"discounted_cash":1611.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRI LUMBAR SPINE WITHOUT CONTRAST","code_information":[{"code":"61615043","type":"CDM"},{"code":"612","type":"RC"},{"code":"72148","type":"HCPCS"}],"standard_charges":[{"gross_charge":2577.0,"discounted_cash":1546.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRI CERVICAL SPINE WITHOUT CONTRAST","code_information":[{"code":"61615068","type":"CDM"},{"code":"612","type":"RC"},{"code":"72141","type":"HCPCS"}],"standard_charges":[{"gross_charge":3108.0,"discounted_cash":1864.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRI ABDOMEN WITHOUT CONTRAST","code_information":[{"code":"61615076","type":"CDM"},{"code":"610","type":"RC"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":2478.0,"discounted_cash":1486.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRI BRAIN W/O CONTRAST","code_information":[{"code":"61615084","type":"CDM"},{"code":"611","type":"RC"},{"code":"70551","type":"HCPCS"}],"standard_charges":[{"gross_charge":3299.0,"discounted_cash":1979.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRI UPPER EXTREMITY JOINT WITHOUT CONTRAST","code_information":[{"code":"61615126","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"HCPCS"}],"standard_charges":[{"gross_charge":2278.0,"discounted_cash":1366.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRI LOWER EXTREMITY JOINT WITHOUT CONTRAST","code_information":[{"code":"61615134","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":2484.0,"discounted_cash":1490.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRI BRAIN W/WO CONTRAST","code_information":[{"code":"61615142","type":"CDM"},{"code":"611","type":"RC"},{"code":"70553","type":"HCPCS"}],"standard_charges":[{"gross_charge":3836.0,"discounted_cash":2301.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRI CERVICAL SPINE WITH WITHOUT CONTRAST","code_information":[{"code":"61615159","type":"CDM"},{"code":"612","type":"RC"},{"code":"72156","type":"HCPCS"}],"standard_charges":[{"gross_charge":3357.0,"discounted_cash":2014.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRI THORACIC SPINE WITH AND WITHOUT CONTRAST","code_information":[{"code":"61615167","type":"CDM"},{"code":"612","type":"RC"},{"code":"72157","type":"HCPCS"}],"standard_charges":[{"gross_charge":4486.0,"discounted_cash":2691.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRI LUMBAR SPINE WITH AND WITHOUT CONTRAST","code_information":[{"code":"61615175","type":"CDM"},{"code":"612","type":"RC"},{"code":"72158","type":"HCPCS"}],"standard_charges":[{"gross_charge":4278.0,"discounted_cash":2566.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRA HEAD WITHOUT CONTRAST","code_information":[{"code":"61615183","type":"CDM"},{"code":"619","type":"RC"},{"code":"70544","type":"HCPCS"}],"standard_charges":[{"gross_charge":3128.0,"discounted_cash":1876.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRI LOWER EXTREMITY WITH WITHOUT CONTRAST","code_information":[{"code":"61615324","type":"CDM"},{"code":"619","type":"RC"},{"code":"73720","type":"HCPCS"}],"standard_charges":[{"gross_charge":3523.0,"discounted_cash":2113.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRI ORBITS OR FACE OR NECK  WITH/WITHOUT CONTRAST","code_information":[{"code":"61615365","type":"CDM"},{"code":"611","type":"RC"},{"code":"70543","type":"HCPCS"}],"standard_charges":[{"gross_charge":3453.0,"discounted_cash":2071.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRI ABDOMEN WITH WITHOUT CONTRAST","code_information":[{"code":"61615407","type":"CDM"},{"code":"610","type":"RC"},{"code":"74183","type":"HCPCS"}],"standard_charges":[{"gross_charge":4130.0,"discounted_cash":2478.0,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRI BRAIN WITH CONTRAST","code_information":[{"code":"61615415","type":"CDM"},{"code":"611","type":"RC"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":3836.0,"discounted_cash":2301.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRA HEAD WITH WITHOUT CONTRAST","code_information":[{"code":"61615431","type":"CDM"},{"code":"611","type":"RC"},{"code":"70546","type":"HCPCS"}],"standard_charges":[{"gross_charge":3316.0,"discounted_cash":1989.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRA NECK WITHOUT CONTRAST","code_information":[{"code":"61615449","type":"CDM"},{"code":"615","type":"RC"},{"code":"70547","type":"HCPCS"}],"standard_charges":[{"gross_charge":1897.0,"discounted_cash":1138.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRA NECK WITH CONTRAST","code_information":[{"code":"61615456","type":"CDM"},{"code":"615","type":"RC"},{"code":"70548","type":"HCPCS"}],"standard_charges":[{"gross_charge":3016.0,"discounted_cash":1809.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRA NECK WITH W/O CONTRAST","code_information":[{"code":"61615464","type":"CDM"},{"code":"615","type":"RC"},{"code":"70549","type":"HCPCS"}],"standard_charges":[{"gross_charge":3167.0,"discounted_cash":1900.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRI PELVIS WITHOUT CONTRAST","code_information":[{"code":"61615472","type":"CDM"},{"code":"619","type":"RC"},{"code":"72195","type":"HCPCS"}],"standard_charges":[{"gross_charge":2047.0,"discounted_cash":1228.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRI PELVIS WITH WITH AND WITOUT CONTRAST","code_information":[{"code":"61615480","type":"CDM"},{"code":"619","type":"RC"},{"code":"72197","type":"HCPCS"}],"standard_charges":[{"gross_charge":3412.0,"discounted_cash":2047.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRI UPPER EXTREM JOINT WITH AND W/O CONTRAST","code_information":[{"code":"61615506","type":"CDM"},{"code":"619","type":"RC"},{"code":"73223","type":"HCPCS"}],"standard_charges":[{"gross_charge":3781.0,"discounted_cash":2268.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRI LOWER EXTREMITY JOINT WITH WITHOUT CONTRAST","code_information":[{"code":"61615522","type":"CDM"},{"code":"619","type":"RC"},{"code":"73723","type":"HCPCS"}],"standard_charges":[{"gross_charge":4123.0,"discounted_cash":2473.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"MRI UPPER EXTREMITY WITH WITHOUT CONTRAST","code_information":[{"code":"61615555","type":"CDM"},{"code":"619","type":"RC"},{"code":"73220","type":"HCPCS"}],"standard_charges":[{"gross_charge":3427.0,"discounted_cash":2056.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"US SOFT TISSUE HEAD/NECK","code_information":[{"code":"61785002","type":"CDM"},{"code":"402","type":"RC"},{"code":"76536","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":419.4,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"U/S COMPLETE ABDOMEN","code_information":[{"code":"61785119","type":"CDM"},{"code":"402","type":"RC"},{"code":"76700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1257.0,"discounted_cash":754.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"U/S PELVIS FOLLOW UP OB PER FETUS","code_information":[{"code":"61785135","type":"CDM"},{"code":"402","type":"RC"},{"code":"76816","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"discounted_cash":304.2,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"U/S PELVIS NON OB","code_information":[{"code":"61785143","type":"CDM"},{"code":"402","type":"RC"},{"code":"76856","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":180.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"U/S LIMITED PELVIS","code_information":[{"code":"61785150","type":"CDM"},{"code":"402","type":"RC"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":180.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"U/S NON OB TRANSVAGINAL","code_information":[{"code":"61785168","type":"CDM"},{"code":"402","type":"RC"},{"code":"76830","type":"HCPCS"}],"standard_charges":[{"gross_charge":731.0,"discounted_cash":438.6,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: 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"}]},{"description":"U/S SCROTUM AND CONTENTS","code_information":[{"code":"61785176","type":"CDM"},{"code":"402","type":"RC"},{"code":"76870","type":"HCPCS"}],"standard_charges":[{"gross_charge":1163.0,"discounted_cash":697.8,"setting":"both","modifier_code":["TC"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier TC: Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. 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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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4925.23,"10th_percentile":4925.23,"90th_percentile":4925.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24445.23,"10th_percentile":24445.23,"90th_percentile":24445.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25605.79,"10th_percentile":25605.79,"90th_percentile":25605.79,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26023.62,"10th_percentile":26023.62,"90th_percentile":26023.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18121.78,"10th_percentile":18121.78,"90th_percentile":18121.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14452.35,"10th_percentile":14452.35,"90th_percentile":14452.35,"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":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4816.48,"10th_percentile":4816.48,"90th_percentile":4816.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":27485.45,"10th_percentile":27485.45,"90th_percentile":27485.45},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5061.08,"10th_percentile":5061.08,"90th_percentile":5061.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6712.43,"10th_percentile":6712.43,"90th_percentile":6712.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W Cc/Mcc Or Major Device","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"G.I. hemorrhage w CC","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20870.84,"10th_percentile":20870.84,"90th_percentile":20870.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22559.9,"10th_percentile":22559.9,"90th_percentile":22559.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13388.0,"10th_percentile":13388.0,"90th_percentile":13388.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12947.0,"10th_percentile":12947.0,"90th_percentile":12947.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1675.0,"10th_percentile":1675.0,"90th_percentile":1675.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[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","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27283.73,"10th_percentile":27283.73,"90th_percentile":27283.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":930.0,"10th_percentile":930.0,"90th_percentile":930.0,"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","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18657.49,"10th_percentile":707.53,"90th_percentile":21019.89,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18828.0,"10th_percentile":18571.89,"90th_percentile":21019.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":23181.9,"10th_percentile":23181.9,"90th_percentile":23181.9},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19375.49,"10th_percentile":19375.49,"90th_percentile":19375.49,"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":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17807.32,"10th_percentile":17807.32,"90th_percentile":17807.32,"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","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6941.16,"10th_percentile":6941.16,"90th_percentile":6941.16,"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":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18463.0,"10th_percentile":18463.0,"90th_percentile":18822.16,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17997.0,"10th_percentile":17997.0,"90th_percentile":17997.0,"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":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":620.0,"10th_percentile":620.0,"90th_percentile":620.0,"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","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":26224.2,"10th_percentile":26224.2,"90th_percentile":26224.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3824.0,"10th_percentile":3824.0,"90th_percentile":3824.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14581.1,"10th_percentile":14581.1,"90th_percentile":14581.1,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23790.85,"10th_percentile":23790.85,"90th_percentile":23790.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24365.46,"10th_percentile":24365.46,"90th_percentile":24365.46,"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":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29442.89,"10th_percentile":29442.89,"90th_percentile":29442.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13932.0,"10th_percentile":10587.0,"90th_percentile":17828.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19045.0,"10th_percentile":14063.0,"90th_percentile":20045.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26455.52,"10th_percentile":26455.52,"90th_percentile":26455.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22862.06,"10th_percentile":22862.06,"90th_percentile":22862.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22115.88,"10th_percentile":22115.88,"90th_percentile":22115.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":23912.34,"10th_percentile":23912.34,"90th_percentile":23912.34},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4777.88,"10th_percentile":4777.88,"90th_percentile":4777.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopy & Incisional Tubal Interruption","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endoscopic Tubal Interruption","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization & Radio-Implant, for Malignancy","code_information":[{"code":"363","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization Except for Malignancy","code_information":[{"code":"364","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures","code_information":[{"code":"365","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16860.0,"10th_percentile":16860.0,"90th_percentile":16860.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13821.88,"10th_percentile":13821.88,"90th_percentile":13821.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14175.34,"10th_percentile":14175.34,"90th_percentile":14175.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23213.6,"10th_percentile":23213.6,"90th_percentile":23213.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":15117.3,"10th_percentile":15117.3,"90th_percentile":15117.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13368.09,"10th_percentile":13368.09,"90th_percentile":13368.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21942.28,"10th_percentile":21942.28,"90th_percentile":21942.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w CC","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. 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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":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39368.0,"10th_percentile":39368.0,"90th_percentile":39368.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15167.29,"10th_percentile":15167.29,"90th_percentile":15167.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning & toxic Effects of Drugs Age >17 w CC","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","code_information":[{"code":"484","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures w/o CC","code_information":[{"code":"530","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5820.42,"10th_percentile":5820.42,"90th_percentile":5820.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1354.11,"10th_percentile":1354.11,"90th_percentile":1354.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4849.94,"10th_percentile":4849.94,"90th_percentile":4849.94,"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":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6864.88,"10th_percentile":5590.02,"90th_percentile":21068.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4905.88,"10th_percentile":4782.21,"90th_percentile":11159.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8342.31,"10th_percentile":8342.31,"90th_percentile":8342.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12755.74,"10th_percentile":12755.74,"90th_percentile":12755.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5743.98,"10th_percentile":5743.98,"90th_percentile":7939.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16539.68,"10th_percentile":16539.68,"90th_percentile":16539.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","code_information":[{"code":"567","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","code_information":[{"code":"568","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small & Large Bowel Procedures w CC w Major Gi Dx","code_information":[{"code":"569","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11356.0,"10th_percentile":11356.0,"90th_percentile":11356.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2000.0,"10th_percentile":2000.0,"90th_percentile":2000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":65.93,"10th_percentile":65.93,"90th_percentile":65.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24839.52,"10th_percentile":23649.03,"90th_percentile":24839.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15499.55,"10th_percentile":15499.55,"90th_percentile":15499.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16396.66,"10th_percentile":16396.66,"90th_percentile":16396.66,"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","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":21671.1,"10th_percentile":21671.1,"90th_percentile":21671.1},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2415.0,"10th_percentile":2415.0,"90th_percentile":2415.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16717.01,"10th_percentile":16717.01,"90th_percentile":16717.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21186.27,"10th_percentile":21186.27,"90th_percentile":21186.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"1 through 10","median_amount":15091.76,"10th_percentile":15091.76,"90th_percentile":15091.76},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14589.95,"10th_percentile":14589.95,"90th_percentile":14589.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19766.0,"10th_percentile":19766.0,"90th_percentile":19766.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1309.35,"10th_percentile":1309.35,"90th_percentile":1309.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":23394.13,"10th_percentile":23394.13,"90th_percentile":23394.13},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4703.51,"10th_percentile":4703.51,"90th_percentile":4703.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15820.86,"10th_percentile":15342.34,"90th_percentile":15857.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17057.76,"10th_percentile":17057.76,"90th_percentile":17861.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23701.65,"10th_percentile":23701.65,"90th_percentile":23701.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17948.83,"10th_percentile":17948.83,"90th_percentile":17948.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31783.76,"10th_percentile":31783.76,"90th_percentile":31783.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16755.0,"10th_percentile":16755.0,"90th_percentile":16755.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1675.0,"10th_percentile":1675.0,"90th_percentile":1675.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":14011.53,"10th_percentile":14011.53,"90th_percentile":14011.53},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7381.0,"10th_percentile":7381.0,"90th_percentile":13059.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15949.73,"10th_percentile":15949.73,"90th_percentile":15949.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21160.14,"10th_percentile":21160.14,"90th_percentile":21160.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":13921.59,"10th_percentile":13921.59,"90th_percentile":13921.59},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7590.0,"10th_percentile":7590.0,"90th_percentile":7590.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23478.45,"10th_percentile":23478.45,"90th_percentile":23478.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8765.0,"10th_percentile":8765.0,"90th_percentile":13839.16,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14288.39,"10th_percentile":14288.39,"90th_percentile":14288.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W Cc/Mcc","code_information":[{"code":"691","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","code_information":[{"code":"692","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21916.0,"10th_percentile":21916.0,"90th_percentile":21916.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20819.29,"10th_percentile":20819.29,"90th_percentile":20819.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","code_information":[{"code":"715","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. 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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":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W Cc/Mcc","code_information":[{"code":"765","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W/O Cc/Mcc","code_information":[{"code":"766","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Sterilization &/Or D&C","code_information":[{"code":"767","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26966.61,"10th_percentile":25324.52,"90th_percentile":26966.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6575.72,"10th_percentile":6575.72,"90th_percentile":6575.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":16506.89,"10th_percentile":16506.89,"90th_percentile":16506.89},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6575.72,"10th_percentile":6575.72,"90th_percentile":6575.72,"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":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6290.13,"10th_percentile":6290.13,"90th_percentile":6290.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":18855.9,"10th_percentile":18855.9,"90th_percentile":18855.9},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":10447.5,"10th_percentile":10447.5,"90th_percentile":10447.5},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30001.08,"10th_percentile":30001.08,"90th_percentile":30001.08,"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":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Complicating Diagnoses","code_information":[{"code":"774","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22420.26,"10th_percentile":22420.26,"90th_percentile":22420.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2565.83,"10th_percentile":2565.83,"90th_percentile":2565.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3082.53,"10th_percentile":3082.53,"90th_percentile":3082.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ectopic Pregnancy","code_information":[{"code":"777","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Threatened Abortion","code_information":[{"code":"778","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"False Labor","code_information":[{"code":"780","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W Medical Complications","code_information":[{"code":"781","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":22440.05,"10th_percentile":22440.05,"90th_percentile":22440.05},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5815.15,"10th_percentile":5815.15,"90th_percentile":5815.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":19851.94,"10th_percentile":19851.94,"90th_percentile":19851.94},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":31600.29,"10th_percentile":31600.29,"90th_percentile":31600.29},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":7321.43,"10th_percentile":7321.43,"90th_percentile":7321.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":8637.86,"10th_percentile":8637.86,"90th_percentile":8637.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":26803.0,"10th_percentile":26803.0,"90th_percentile":26803.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26556.86,"10th_percentile":26556.86,"90th_percentile":26556.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":7321.44,"10th_percentile":6014.24,"90th_percentile":7321.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":19401.34,"10th_percentile":19401.34,"90th_percentile":19401.34},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":15972.03,"10th_percentile":15972.03,"90th_percentile":15972.03},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":9107.13,"10th_percentile":9107.13,"90th_percentile":9107.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6981.74,"10th_percentile":6981.74,"90th_percentile":6981.74,"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":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":22693.0,"10th_percentile":22693.0,"90th_percentile":22693.0},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18301.9,"10th_percentile":18301.9,"90th_percentile":18301.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24691.05,"10th_percentile":21356.97,"90th_percentile":24691.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6014.24,"10th_percentile":6014.24,"90th_percentile":7321.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":25424.56,"10th_percentile":25424.56,"90th_percentile":33883.32},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":20380.35,"10th_percentile":20380.35,"90th_percentile":20380.35},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5769.38,"10th_percentile":5769.38,"90th_percentile":6981.74,"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":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":24044.1,"10th_percentile":24044.1,"90th_percentile":24044.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35355.05,"10th_percentile":35355.05,"90th_percentile":35355.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":718.73,"10th_percentile":718.73,"90th_percentile":1146.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"1 through 10","median_amount":1250.91,"10th_percentile":1250.91,"90th_percentile":1250.91},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1068.8,"10th_percentile":1068.8,"90th_percentile":1855.15,"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":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"1 through 10","median_amount":2535.79,"10th_percentile":2535.79,"90th_percentile":2535.79},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4098.0,"10th_percentile":4098.0,"90th_percentile":4098.0,"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":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1713.78,"10th_percentile":1713.78,"90th_percentile":1713.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31478.51,"10th_percentile":31478.51,"90th_percentile":31478.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1713.78,"10th_percentile":1643.29,"90th_percentile":2070.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1713.78,"10th_percentile":1713.78,"90th_percentile":3319.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"11","median_amount":1925.64,"10th_percentile":1594.55,"90th_percentile":1925.64,"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":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":13176.0,"10th_percentile":89.69,"90th_percentile":16319.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"20","median_amount":1713.78,"10th_percentile":1713.78,"90th_percentile":2070.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"18","median_amount":1713.78,"10th_percentile":1643.29,"90th_percentile":1713.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1713.78,"10th_percentile":1713.78,"90th_percentile":1713.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"27","median_amount":1594.55,"10th_percentile":1524.06,"90th_percentile":1594.55,"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":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":3003.3,"10th_percentile":3003.3,"90th_percentile":3003.3},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":12855.2,"10th_percentile":12855.2,"90th_percentile":12855.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6631.07,"10th_percentile":6631.07,"90th_percentile":6631.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6341.45,"10th_percentile":6341.45,"90th_percentile":6341.45,"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":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25445.21,"10th_percentile":25445.21,"90th_percentile":25445.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6631.07,"10th_percentile":6631.07,"90th_percentile":6631.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5643.59,"10th_percentile":5643.59,"90th_percentile":5643.59,"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":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":10990.8,"10th_percentile":10990.8,"90th_percentile":10990.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9801.1,"10th_percentile":2418.98,"90th_percentile":22540.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5878.58,"10th_percentile":5878.58,"90th_percentile":7094.01,"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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":9789.11,"10th_percentile":9789.11,"90th_percentile":9789.11},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":6683.99,"10th_percentile":6683.99,"90th_percentile":16103.41},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":7153.92,"10th_percentile":7153.92,"90th_percentile":7153.92},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":21515.27,"10th_percentile":14553.0,"90th_percentile":21528.42,"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":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"18","median_amount":5358.95,"10th_percentile":5358.95,"90th_percentile":5878.58,"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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":13430.2,"10th_percentile":8452.0,"90th_percentile":16130.77},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":11326.29,"10th_percentile":11326.29,"90th_percentile":17804.03},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20083.14,"10th_percentile":20083.14,"90th_percentile":20083.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37249.34,"10th_percentile":37249.34,"90th_percentile":37249.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5727.56,"10th_percentile":5727.56,"90th_percentile":5727.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15675.0,"10th_percentile":15675.0,"90th_percentile":15675.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22905.8,"10th_percentile":22905.8,"90th_percentile":22905.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19801.78,"10th_percentile":19801.78,"90th_percentile":19801.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":13998.7,"10th_percentile":13998.7,"90th_percentile":13998.7},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"1 through 10","median_amount":24196.89,"10th_percentile":24196.89,"90th_percentile":24196.89},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21358.49,"10th_percentile":21358.49,"90th_percentile":21358.49,"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":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24423.86,"10th_percentile":23521.02,"90th_percentile":24423.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":4661.36,"10th_percentile":4661.36,"90th_percentile":4661.36},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16617.4,"10th_percentile":16617.4,"90th_percentile":16617.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16695.2,"10th_percentile":16695.2,"90th_percentile":16695.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":414.33,"10th_percentile":414.33,"90th_percentile":414.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5341.14,"10th_percentile":5341.14,"90th_percentile":16591.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7510.66,"10th_percentile":7510.66,"90th_percentile":7510.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14070.17,"10th_percentile":14070.17,"90th_percentile":14070.17,"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":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":28774.44,"10th_percentile":28774.44,"90th_percentile":28774.44},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7812.02,"10th_percentile":7812.02,"90th_percentile":7812.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9427.54,"10th_percentile":9427.54,"90th_percentile":9427.54,"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":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6462.2,"10th_percentile":5530.7,"90th_percentile":7584.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":6877.7,"10th_percentile":4819.09,"90th_percentile":8430.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":6350.92,"10th_percentile":4045.69,"90th_percentile":8458.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12486.7,"10th_percentile":12486.7,"90th_percentile":12486.7,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9521.46,"10th_percentile":9521.46,"90th_percentile":9521.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12612.0,"10th_percentile":12612.0,"90th_percentile":12612.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","code_information":[{"code":"984","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":97.02,"10th_percentile":97.02,"90th_percentile":97.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":9087.67,"10th_percentile":9087.67,"90th_percentile":9087.67},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":120.02,"10th_percentile":120.02,"90th_percentile":611.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":558.51,"10th_percentile":66.17,"90th_percentile":2024.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"14","median_amount":1437.56,"10th_percentile":361.05,"90th_percentile":11339.46},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":143.59,"10th_percentile":143.59,"90th_percentile":143.59},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":67.73,"10th_percentile":67.73,"90th_percentile":520.33,"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":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":520.33,"10th_percentile":520.33,"90th_percentile":1950.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"15","median_amount":78.33,"10th_percentile":59.21,"90th_percentile":346.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":151.2,"10th_percentile":151.2,"90th_percentile":154.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":151.94,"10th_percentile":151.94,"90th_percentile":151.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":83.21,"10th_percentile":83.21,"90th_percentile":83.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":413.59,"10th_percentile":413.59,"90th_percentile":3428.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":143.23,"10th_percentile":143.23,"90th_percentile":143.23},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"183","median_amount":215.87,"10th_percentile":210.74,"90th_percentile":216.91,"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":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"60","median_amount":135.08,"10th_percentile":132.32,"90th_percentile":291.42,"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":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":136.26,"10th_percentile":136.26,"90th_percentile":136.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"63","median_amount":292.16,"10th_percentile":143.91,"90th_percentile":654.87},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":142.71,"10th_percentile":142.71,"90th_percentile":143.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"19","median_amount":620.01,"10th_percentile":284.69,"90th_percentile":1148.72},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"44","median_amount":135.08,"10th_percentile":132.32,"90th_percentile":294.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":286.31,"10th_percentile":132.32,"90th_percentile":439.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":305.61,"10th_percentile":305.61,"90th_percentile":826.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":143.52,"10th_percentile":143.52,"90th_percentile":143.52,"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":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"158","median_amount":78.33,"10th_percentile":78.33,"90th_percentile":252.22,"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","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":78.33,"10th_percentile":78.33,"90th_percentile":126.0,"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":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":437.4,"10th_percentile":342.9,"90th_percentile":791.1},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":148.88,"10th_percentile":148.88,"90th_percentile":148.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"18","median_amount":340.2,"10th_percentile":302.4,"90th_percentile":1019.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"33","median_amount":148.88,"10th_percentile":143.73,"90th_percentile":149.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":149.18,"10th_percentile":149.18,"90th_percentile":149.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":149.67,"10th_percentile":149.67,"90th_percentile":150.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":858.36,"10th_percentile":847.92,"90th_percentile":1717.64},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":872.0,"10th_percentile":872.0,"90th_percentile":877.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1062","median_amount":379.5,"10th_percentile":367.62,"90th_percentile":727.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"350","median_amount":323.98,"10th_percentile":202.42,"90th_percentile":560.49,"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":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient 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":350.31,"10th_percentile":210.52,"90th_percentile":494.24,"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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"420","median_amount":719.61,"10th_percentile":380.43,"90th_percentile":1469.1},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"33","median_amount":249.77,"10th_percentile":247.59,"90th_percentile":466.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"1 through 10","median_amount":202.38,"10th_percentile":202.38,"90th_percentile":202.38},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"122","median_amount":844.94,"10th_percentile":441.56,"90th_percentile":1726.4},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"68","median_amount":874.96,"10th_percentile":489.16,"90th_percentile":1662.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":258.45,"10th_percentile":249.78,"90th_percentile":356.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":597.85,"10th_percentile":597.85,"90th_percentile":597.85},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"1 through 10","median_amount":1539.0,"10th_percentile":1539.0,"90th_percentile":1539.0,"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","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"860","median_amount":78.33,"10th_percentile":77.97,"90th_percentile":266.77,"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":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"61","median_amount":78.33,"10th_percentile":78.33,"90th_percentile":312.54,"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":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":781.2,"10th_percentile":781.2,"90th_percentile":781.2},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"61","median_amount":998.1,"10th_percentile":651.6,"90th_percentile":2022.0},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"35","median_amount":258.95,"10th_percentile":256.45,"90th_percentile":497.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"152","median_amount":819.0,"10th_percentile":458.1,"90th_percentile":1929.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"338","median_amount":258.95,"10th_percentile":251.79,"90th_percentile":477.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"170","median_amount":258.95,"10th_percentile":250.79,"90th_percentile":466.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":261.68,"10th_percentile":124.41,"90th_percentile":568.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":3816.72,"10th_percentile":3816.72,"90th_percentile":4977.2},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"681","median_amount":949.58,"10th_percentile":499.7,"90th_percentile":1411.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"113","median_amount":841.62,"10th_percentile":481.45,"90th_percentile":2280.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":601.36,"10th_percentile":601.36,"90th_percentile":601.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"279","median_amount":2432.73,"10th_percentile":646.17,"90th_percentile":5170.9},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":580.2,"10th_percentile":380.22,"90th_percentile":968.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"80","median_amount":3032.82,"10th_percentile":1835.13,"90th_percentile":5294.57},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"102","median_amount":767.82,"10th_percentile":442.83,"90th_percentile":2069.01,"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":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":837.69,"10th_percentile":521.07,"90th_percentile":4904.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"45","median_amount":3495.4,"10th_percentile":1493.32,"90th_percentile":4756.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":716.52,"10th_percentile":477.94,"90th_percentile":950.27,"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":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":4066.2,"10th_percentile":4066.2,"90th_percentile":4066.2},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1102.25,"10th_percentile":1102.25,"90th_percentile":1102.25},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":3829.96,"10th_percentile":3829.96,"90th_percentile":5558.64},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"1 through 10","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"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","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"269","median_amount":78.33,"10th_percentile":77.97,"90th_percentile":1481.56,"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":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"20","median_amount":535.83,"10th_percentile":78.33,"90th_percentile":1597.93,"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":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":3408.75,"10th_percentile":3408.75,"90th_percentile":3408.75},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"39","median_amount":3803.4,"10th_percentile":1959.3,"90th_percentile":7162.2},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"33","median_amount":787.11,"10th_percentile":495.4,"90th_percentile":1155.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"72","median_amount":3681.0,"10th_percentile":1291.5,"90th_percentile":6942.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"247","median_amount":721.27,"10th_percentile":402.99,"90th_percentile":1045.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"167","median_amount":684.93,"10th_percentile":478.45,"90th_percentile":1068.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":630.89,"10th_percentile":147.12,"90th_percentile":2459.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":3114.2,"10th_percentile":3114.2,"90th_percentile":3114.2},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5037.0,"10th_percentile":5037.0,"90th_percentile":5037.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"217","median_amount":1277.23,"10th_percentile":835.73,"90th_percentile":3609.15,"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":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"24","median_amount":1202.33,"10th_percentile":842.06,"90th_percentile":3572.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"122","median_amount":3755.75,"10th_percentile":1786.0,"90th_percentile":8384.66},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":1168.7,"10th_percentile":813.05,"90th_percentile":2541.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"38","median_amount":4069.5,"10th_percentile":2005.29,"90th_percentile":7864.25},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"18","median_amount":958.76,"10th_percentile":846.35,"90th_percentile":5219.11,"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":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"24","median_amount":4360.57,"10th_percentile":2043.96,"90th_percentile":7542.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":777.83,"10th_percentile":651.4,"90th_percentile":1186.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":7257.88,"10th_percentile":7257.88,"90th_percentile":7257.88},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"53","median_amount":1185.92,"10th_percentile":78.33,"90th_percentile":3333.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1003.47,"10th_percentile":1003.47,"90th_percentile":1003.47,"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":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"16","median_amount":3557.7,"10th_percentile":2799.0,"90th_percentile":10611.0},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":1290.11,"10th_percentile":839.52,"90th_percentile":2624.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"37","median_amount":3923.1,"10th_percentile":2521.78,"90th_percentile":10388.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"212","median_amount":944.77,"10th_percentile":107.8,"90th_percentile":2571.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"137","median_amount":1061.23,"10th_percentile":651.91,"90th_percentile":2624.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":978.48,"10th_percentile":158.74,"90th_percentile":2543.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":486.73,"10th_percentile":468.7,"90th_percentile":486.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":383.58,"10th_percentile":383.58,"90th_percentile":383.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":807.59,"10th_percentile":807.59,"90th_percentile":807.59},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":824.19,"10th_percentile":824.19,"90th_percentile":824.19},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":871.41,"10th_percentile":871.41,"90th_percentile":871.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":349.98,"10th_percentile":349.98,"90th_percentile":385.17,"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":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":332.92,"10th_percentile":332.92,"90th_percentile":332.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":922.04,"10th_percentile":922.04,"90th_percentile":922.04,"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":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":1027.54,"10th_percentile":1027.54,"90th_percentile":1027.54},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":1534.67,"10th_percentile":1534.67,"90th_percentile":1534.67},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":642.73,"10th_percentile":642.73,"90th_percentile":642.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":366.57,"10th_percentile":366.57,"90th_percentile":771.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":388.6,"10th_percentile":388.6,"90th_percentile":388.6,"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":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":518.92,"10th_percentile":518.92,"90th_percentile":518.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":378.05,"10th_percentile":378.05,"90th_percentile":378.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":1170.3,"10th_percentile":1170.3,"90th_percentile":1170.3},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":573.65,"10th_percentile":573.65,"90th_percentile":573.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1424.97,"10th_percentile":1424.97,"90th_percentile":1424.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3661.17,"10th_percentile":3661.17,"90th_percentile":3661.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4240.29,"10th_percentile":4240.29,"90th_percentile":4240.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4477.82,"10th_percentile":4477.82,"90th_percentile":4477.82,"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":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":488.16,"10th_percentile":488.16,"90th_percentile":488.16,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2659.04,"10th_percentile":2659.04,"90th_percentile":2659.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":5572.62,"10th_percentile":5491.29,"90th_percentile":8330.3},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1428.64,"10th_percentile":1428.64,"90th_percentile":1428.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":2283.54,"10th_percentile":2283.54,"90th_percentile":2283.54},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":5974.2,"10th_percentile":5974.2,"90th_percentile":5974.2},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4501.3,"10th_percentile":4501.3,"90th_percentile":4501.3,"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","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":411.93,"10th_percentile":411.93,"90th_percentile":411.93,"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":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1412.97,"10th_percentile":1412.97,"90th_percentile":1412.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":5895.0,"10th_percentile":5895.0,"90th_percentile":5895.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1412.59,"10th_percentile":1412.59,"90th_percentile":1438.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1412.97,"10th_percentile":1412.97,"90th_percentile":1430.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4170.57,"10th_percentile":4170.57,"90th_percentile":4170.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":9626.34,"10th_percentile":9626.34,"90th_percentile":13516.55},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":11766.08,"10th_percentile":11766.08,"90th_percentile":11766.08},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6135.12,"10th_percentile":4011.3,"90th_percentile":6135.12,"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":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3859.99,"10th_percentile":3859.99,"90th_percentile":3859.99,"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","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2909.8,"10th_percentile":2909.8,"90th_percentile":2909.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3006.67,"10th_percentile":3006.67,"90th_percentile":3018.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3018.46,"10th_percentile":3018.46,"90th_percentile":3018.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6751.46,"10th_percentile":6751.46,"90th_percentile":6751.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9737.69,"10th_percentile":9737.69,"90th_percentile":9737.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":7349.86,"10th_percentile":7349.86,"90th_percentile":7349.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4571.06,"10th_percentile":4571.06,"90th_percentile":4571.06,"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","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6257.97,"10th_percentile":6257.97,"90th_percentile":6257.97,"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":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":37026.0,"10th_percentile":37026.0,"90th_percentile":37026.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6617.15,"10th_percentile":6617.15,"90th_percentile":6617.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":25213.5,"10th_percentile":25213.5,"90th_percentile":25213.5},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 ENT Procedures","code_information":[{"code":"5163","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2298.75,"10th_percentile":2298.75,"90th_percentile":2298.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4290.39,"10th_percentile":4290.39,"90th_percentile":4290.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":16729.2,"10th_percentile":16729.2,"90th_percentile":16729.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2812.98,"10th_percentile":2812.98,"90th_percentile":2812.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":63.7,"10th_percentile":63.7,"90th_percentile":63.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2009.55,"10th_percentile":2009.55,"90th_percentile":2009.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":732.4,"10th_percentile":732.4,"90th_percentile":732.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1186.47,"10th_percentile":1186.47,"90th_percentile":1186.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1303.59,"10th_percentile":1303.59,"90th_percentile":1303.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":1278.0,"10th_percentile":1167.98,"90th_percentile":1899.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":3488.49,"10th_percentile":3119.16,"90th_percentile":4117.63},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1475.13,"10th_percentile":1475.13,"90th_percentile":1475.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":3445.33,"10th_percentile":2999.35,"90th_percentile":9741.44},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":3962.3,"10th_percentile":3032.09,"90th_percentile":8544.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1298.06,"10th_percentile":1298.06,"90th_percentile":1298.06,"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":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1264.46,"10th_percentile":1264.46,"90th_percentile":1264.46,"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","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":3626.1,"10th_percentile":3626.1,"90th_percentile":3680.1},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":876.86,"10th_percentile":876.86,"90th_percentile":3724.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":4535.11,"10th_percentile":4054.5,"90th_percentile":4876.2},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1472.94,"10th_percentile":1472.94,"90th_percentile":2001.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":870.36,"10th_percentile":869.36,"90th_percentile":1225.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1702.03,"10th_percentile":1702.03,"90th_percentile":1702.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":2702.04,"10th_percentile":2702.04,"90th_percentile":2702.04},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"46","median_amount":1242.77,"10th_percentile":1177.61,"90th_percentile":1242.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1184.1,"10th_percentile":1184.1,"90th_percentile":1184.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"48","median_amount":2465.93,"10th_percentile":2096.59,"90th_percentile":2602.89},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":811.94,"10th_percentile":811.94,"90th_percentile":811.94,"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":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"30","median_amount":2465.93,"10th_percentile":15.77,"90th_percentile":2569.69},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2656.99,"10th_percentile":2633.82,"90th_percentile":3114.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1252.83,"10th_percentile":1252.83,"90th_percentile":1252.83,"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":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2761.2,"10th_percentile":2761.2,"90th_percentile":2761.2},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2619.0,"10th_percentile":2619.0,"90th_percentile":2619.0},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":994.96,"10th_percentile":994.96,"90th_percentile":994.96,"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","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2673.91,"10th_percentile":2655.0,"90th_percentile":2772.9},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":814.82,"10th_percentile":814.82,"90th_percentile":814.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"18","median_amount":2686.5,"10th_percentile":2444.4,"90th_percentile":2753.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":844.42,"10th_percentile":800.15,"90th_percentile":844.42,"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":844.42,"10th_percentile":801.15,"90th_percentile":846.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":861.65,"10th_percentile":861.65,"90th_percentile":861.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":2989.08,"10th_percentile":2989.08,"90th_percentile":2989.08},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"31","median_amount":1607.22,"10th_percentile":1520.49,"90th_percentile":1656.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2328.0,"10th_percentile":2328.0,"90th_percentile":2328.0,"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":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"21","median_amount":2739.56,"10th_percentile":1927.0,"90th_percentile":3371.05},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1050.05,"10th_percentile":1050.05,"90th_percentile":1054.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"16","median_amount":2735.68,"10th_percentile":450.8,"90th_percentile":3112.23},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2955.47,"10th_percentile":2955.47,"90th_percentile":3281.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1092.05,"10th_percentile":1092.05,"90th_percentile":1092.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2990.71,"10th_percentile":2990.71,"90th_percentile":2990.71},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2982.61,"10th_percentile":2982.6,"90th_percentile":3964.5},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1580.66,"10th_percentile":1580.66,"90th_percentile":1739.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"17","median_amount":3143.7,"10th_percentile":2982.6,"90th_percentile":5418.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":1092.06,"10th_percentile":1092.06,"90th_percentile":1092.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":1092.06,"10th_percentile":1053.77,"90th_percentile":1638.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":22631.08,"10th_percentile":22631.08,"90th_percentile":22631.08},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7676.3,"10th_percentile":7434.45,"90th_percentile":7954.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6748.63,"10th_percentile":6748.63,"90th_percentile":6748.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":18029.26,"10th_percentile":737.59,"90th_percentile":28856.61},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":18568.76,"10th_percentile":12238.91,"90th_percentile":29008.5},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6260.99,"10th_percentile":6260.99,"90th_percentile":6260.99,"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","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":14061.6,"10th_percentile":14061.6,"90th_percentile":14061.6},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":32757.29,"10th_percentile":32757.29,"90th_percentile":32757.29},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":14195.3,"10th_percentile":14193.14,"90th_percentile":14200.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":24879.25,"10th_percentile":17535.68,"90th_percentile":45874.12},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":24756.41,"10th_percentile":24756.41,"90th_percentile":27831.56},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6135.12,"10th_percentile":6135.12,"90th_percentile":6135.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9646.82,"10th_percentile":9646.82,"90th_percentile":9646.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6261.93,"10th_percentile":6261.93,"90th_percentile":6261.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":32146.2,"10th_percentile":32146.2,"90th_percentile":32295.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Urology and Related Services","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":273.7,"10th_percentile":273.7,"90th_percentile":273.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":151.63,"10th_percentile":151.63,"90th_percentile":151.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2792.34,"10th_percentile":2792.34,"90th_percentile":2792.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3.1,"10th_percentile":3.1,"90th_percentile":3.1,"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","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4708.4,"10th_percentile":4708.4,"90th_percentile":4708.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4715.1,"10th_percentile":4715.1,"90th_percentile":4715.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":556.29,"10th_percentile":556.29,"90th_percentile":556.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":559.21,"10th_percentile":559.21,"90th_percentile":789.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":1604.39,"10th_percentile":1604.39,"90th_percentile":1604.39},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":1012.6,"10th_percentile":1012.6,"90th_percentile":1012.6},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":548.81,"10th_percentile":548.81,"90th_percentile":548.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2000.29,"10th_percentile":2000.29,"90th_percentile":2000.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":818.85,"10th_percentile":818.85,"90th_percentile":1438.78,"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":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2200.53,"10th_percentile":2200.53,"90th_percentile":2200.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":1226.74,"10th_percentile":1226.74,"90th_percentile":1226.74},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":1587.79,"10th_percentile":1587.79,"90th_percentile":1587.79},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Gynecologic Procedures","code_information":[{"code":"5413","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1187.84,"10th_percentile":1187.84,"90th_percentile":1187.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":813.18,"10th_percentile":813.18,"90th_percentile":813.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":4335.1,"10th_percentile":4028.22,"90th_percentile":4365.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4628.23,"10th_percentile":4628.23,"90th_percentile":4628.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"11","median_amount":13558.05,"10th_percentile":3448.66,"90th_percentile":13798.75},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2843.82,"10th_percentile":2843.82,"90th_percentile":2843.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":13560.54,"10th_percentile":9622.19,"90th_percentile":14617.96},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":13625.21,"10th_percentile":13625.21,"90th_percentile":14717.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":478.55,"10th_percentile":478.55,"90th_percentile":478.55,"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":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient 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":3954.71,"10th_percentile":2533.34,"90th_percentile":5641.59,"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","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":15351.31,"10th_percentile":15351.31,"90th_percentile":15351.31},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":11945.7,"10th_percentile":11061.0,"90th_percentile":12645.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2956.4,"10th_percentile":2956.4,"90th_percentile":2956.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":6729.97,"10th_percentile":6408.74,"90th_percentile":6731.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":12918.12,"10th_percentile":12918.12,"90th_percentile":12918.12},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":15051.7,"10th_percentile":15051.7,"90th_percentile":15051.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":6875.45,"10th_percentile":6875.45,"90th_percentile":6875.45},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1741.57,"10th_percentile":1741.57,"90th_percentile":1741.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1697.05,"10th_percentile":1697.05,"90th_percentile":1697.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":10151.1,"10th_percentile":10151.1,"90th_percentile":10151.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1816.35,"10th_percentile":1815.73,"90th_percentile":1816.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1815.73,"10th_percentile":1815.73,"90th_percentile":1815.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":752.48,"10th_percentile":752.48,"90th_percentile":752.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":573.41,"10th_percentile":573.41,"90th_percentile":573.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1542.6,"10th_percentile":1542.6,"90th_percentile":1542.6},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":532.36,"10th_percentile":532.36,"90th_percentile":532.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":513.36,"10th_percentile":513.36,"90th_percentile":860.0},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":117.09,"10th_percentile":117.09,"90th_percentile":117.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"185","median_amount":120.02,"10th_percentile":117.09,"90th_percentile":259.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"43","median_amount":219.75,"10th_percentile":79.55,"90th_percentile":290.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"124","median_amount":463.14,"10th_percentile":149.4,"90th_percentile":907.19},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":78.41,"10th_percentile":78.41,"90th_percentile":166.01,"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":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"78","median_amount":388.44,"10th_percentile":162.64,"90th_percentile":541.16},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"23","median_amount":497.18,"10th_percentile":335.91,"90th_percentile":580.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":81.95,"10th_percentile":79.09,"90th_percentile":174.94,"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":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"136","median_amount":192.07,"10th_percentile":61.96,"90th_percentile":215.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":191.08,"10th_percentile":61.96,"90th_percentile":192.07,"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":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"29","median_amount":437.4,"10th_percentile":213.3,"90th_percentile":1312.2},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":81.85,"10th_percentile":81.69,"90th_percentile":171.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"49","median_amount":502.2,"10th_percentile":162.0,"90th_percentile":837.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"145","median_amount":81.87,"10th_percentile":79.86,"90th_percentile":95.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"128","median_amount":81.55,"10th_percentile":78.8,"90th_percentile":101.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":83.21,"10th_percentile":83.21,"90th_percentile":83.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":672.52,"10th_percentile":672.52,"90th_percentile":735.08},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"345","median_amount":144.96,"10th_percentile":141.66,"90th_percentile":144.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"67","median_amount":327.65,"10th_percentile":133.11,"90th_percentile":772.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":452.12,"10th_percentile":452.12,"90th_percentile":452.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"223","median_amount":690.56,"10th_percentile":157.7,"90th_percentile":1254.96},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"57","median_amount":94.71,"10th_percentile":94.71,"90th_percentile":192.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"1 through 10","median_amount":580.17,"10th_percentile":580.17,"90th_percentile":580.17},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"118","median_amount":731.23,"10th_percentile":299.63,"90th_percentile":1397.72},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"43","median_amount":784.97,"10th_percentile":238.79,"90th_percentile":1746.36,"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":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":98.5,"10th_percentile":96.98,"90th_percentile":200.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"1 through 10","median_amount":1254.0,"10th_percentile":1254.0,"90th_percentile":1254.0,"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","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"205","median_amount":240.6,"10th_percentile":92.25,"90th_percentile":510.38,"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":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":240.6,"10th_percentile":124.25,"90th_percentile":410.97,"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":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":1568.0,"10th_percentile":1568.0,"90th_percentile":1568.0},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"51","median_amount":783.0,"10th_percentile":270.9,"90th_percentile":1585.8},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"44","median_amount":100.51,"10th_percentile":98.22,"90th_percentile":200.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"72","median_amount":719.1,"10th_percentile":118.8,"90th_percentile":1382.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"277","median_amount":98.89,"10th_percentile":96.26,"90th_percentile":200.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"262","median_amount":98.5,"10th_percentile":96.26,"90th_percentile":200.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":100.51,"10th_percentile":98.22,"90th_percentile":100.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":2370.84,"10th_percentile":2370.84,"90th_percentile":2370.84},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":315.72,"10th_percentile":315.72,"90th_percentile":315.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"120","median_amount":329.49,"10th_percentile":315.72,"90th_percentile":329.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1299.21,"10th_percentile":1299.21,"90th_percentile":1299.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"66","median_amount":2138.91,"10th_percentile":742.85,"90th_percentile":2738.17},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":216.15,"10th_percentile":216.15,"90th_percentile":310.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"1 through 10","median_amount":2577.0,"10th_percentile":2577.0,"90th_percentile":2577.0},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"25","median_amount":2138.91,"10th_percentile":742.85,"90th_percentile":2694.18},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1027.47,"10th_percentile":1027.47,"90th_percentile":1027.47,"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":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2296.11,"10th_percentile":1155.63,"90th_percentile":2939.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":226.88,"10th_percentile":226.88,"90th_percentile":226.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2859.36,"10th_percentile":2859.36,"90th_percentile":2859.36},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient 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":887.02,"10th_percentile":855.01,"90th_percentile":1135.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"17","median_amount":2322.0,"10th_percentile":2050.2,"90th_percentile":4847.4},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":228.45,"10th_percentile":226.89,"90th_percentile":794.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"18","median_amount":2322.0,"10th_percentile":1321.2,"90th_percentile":3108.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"115","median_amount":224.76,"10th_percentile":216.88,"90th_percentile":484.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"128","median_amount":228.45,"10th_percentile":216.88,"90th_percentile":323.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":228.45,"10th_percentile":218.9,"90th_percentile":228.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":2800.0,"10th_percentile":2800.0,"90th_percentile":2800.0},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"80","median_amount":747.39,"10th_percentile":710.82,"90th_percentile":747.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1102.69,"10th_percentile":1102.69,"90th_percentile":1144.04,"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":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"67","median_amount":2324.0,"10th_percentile":2324.0,"90th_percentile":2800.0},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"34","median_amount":488.29,"10th_percentile":471.17,"90th_percentile":678.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"40","median_amount":2324.0,"10th_percentile":2324.0,"90th_percentile":2555.57},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2494.8,"10th_percentile":2494.8,"90th_percentile":5434.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":510.83,"10th_percentile":493.02,"90th_percentile":841.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2576.0,"10th_percentile":2576.0,"90th_percentile":2576.0},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":963.77,"10th_percentile":209.09,"90th_percentile":963.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"12","median_amount":2520.0,"10th_percentile":2520.0,"90th_percentile":2842.2},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":510.83,"10th_percentile":494.62,"90th_percentile":709.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"19","median_amount":2520.0,"10th_percentile":2520.0,"90th_percentile":2800.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"115","median_amount":509.82,"10th_percentile":484.88,"90th_percentile":512.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"119","median_amount":509.82,"10th_percentile":484.88,"90th_percentile":512.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":518.19,"10th_percentile":118.17,"90th_percentile":518.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":2445.36,"10th_percentile":2445.36,"90th_percentile":2445.36},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"63","median_amount":242.66,"10th_percentile":236.73,"90th_percentile":593.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":229.99,"10th_percentile":179.58,"90th_percentile":1669.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"25","median_amount":2472.74,"10th_percentile":484.72,"90th_percentile":5214.48},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":158.53,"10th_percentile":158.53,"90th_percentile":389.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"17","median_amount":484.72,"10th_percentile":158.53,"90th_percentile":4323.06},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":179.58,"10th_percentile":179.58,"90th_percentile":1211.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":211.87,"10th_percentile":211.87,"90th_percentile":211.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":520.34,"10th_percentile":406.3,"90th_percentile":6023.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":391.87,"10th_percentile":167.88,"90th_percentile":406.01,"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":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"12","median_amount":185.18,"10th_percentile":156.96,"90th_percentile":1270.47,"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":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":467.2,"10th_percentile":467.2,"90th_percentile":4113.0},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":264.02,"10th_percentile":165.38,"90th_percentile":408.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":3321.9,"10th_percentile":410.4,"90th_percentile":6023.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"48","median_amount":168.24,"10th_percentile":161.48,"90th_percentile":404.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"49","median_amount":251.01,"10th_percentile":162.34,"90th_percentile":404.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":411.23,"10th_percentile":168.24,"90th_percentile":411.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"52","median_amount":486.81,"10th_percentile":486.81,"90th_percentile":1093.64,"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":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1707.59,"10th_percentile":1707.59,"90th_percentile":1736.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"26","median_amount":3415.46,"10th_percentile":3183.88,"90th_percentile":3839.58},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":319.35,"10th_percentile":319.35,"90th_percentile":324.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":3427.9,"10th_percentile":3183.88,"90th_percentile":4966.72},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":3590.73,"10th_percentile":3590.73,"90th_percentile":3590.73,"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":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":333.77,"10th_percentile":333.77,"90th_percentile":333.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":3935.76,"10th_percentile":3935.76,"90th_percentile":3935.76},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1492.48,"10th_percentile":1308.66,"90th_percentile":1575.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":4115.0,"10th_percentile":3902.4,"90th_percentile":4525.2},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":339.58,"10th_percentile":339.58,"90th_percentile":796.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"16","median_amount":3902.4,"10th_percentile":3272.4,"90th_percentile":4403.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"38","median_amount":332.07,"10th_percentile":332.07,"90th_percentile":732.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"33","median_amount":335.77,"10th_percentile":324.18,"90th_percentile":415.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":72.83,"10th_percentile":69.83,"90th_percentile":103.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":81.08,"10th_percentile":81.08,"90th_percentile":81.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":284.69,"10th_percentile":284.69,"90th_percentile":466.46},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":403.55,"10th_percentile":403.55,"90th_percentile":403.55,"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":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":170.83,"10th_percentile":73.72,"90th_percentile":368.6,"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":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":308.7,"10th_percentile":308.7,"90th_percentile":308.7},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":308.7,"10th_percentile":308.7,"90th_percentile":308.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":47.75,"10th_percentile":47.45,"90th_percentile":49.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":1325.72,"10th_percentile":1325.72,"90th_percentile":1325.72},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":233.58,"10th_percentile":233.58,"90th_percentile":233.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":651.56,"10th_percentile":651.56,"90th_percentile":651.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"11","median_amount":1201.84,"10th_percentile":1016.75,"90th_percentile":1827.66},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":1451.67,"10th_percentile":1201.84,"90th_percentile":2392.06},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":33.92,"10th_percentile":33.92,"90th_percentile":33.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2327.3,"10th_percentile":2327.3,"90th_percentile":2327.3,"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":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":159.11,"10th_percentile":159.11,"90th_percentile":159.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":280.34,"10th_percentile":242.74,"90th_percentile":355.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1673.1,"10th_percentile":1673.1,"90th_percentile":1673.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":153.15,"10th_percentile":153.15,"90th_percentile":153.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":483.0,"10th_percentile":463.14,"90th_percentile":2494.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":4075.51,"10th_percentile":4075.51,"90th_percentile":4075.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":337.11,"10th_percentile":337.11,"90th_percentile":337.11,"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":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5398.9,"10th_percentile":1967.87,"90th_percentile":6452.0,"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":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3553.42,"10th_percentile":3553.42,"90th_percentile":3553.42,"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":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"15","median_amount":11081.34,"10th_percentile":4612.0,"90th_percentile":15307.59},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":6698.93,"10th_percentile":4095.22,"90th_percentile":14666.93},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":2360.28,"10th_percentile":2360.28,"90th_percentile":2360.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2415.51,"10th_percentile":2415.51,"90th_percentile":2454.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2047.14,"10th_percentile":2047.14,"90th_percentile":2047.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1441.42,"10th_percentile":1214.22,"90th_percentile":3173.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":97.02,"10th_percentile":97.02,"90th_percentile":97.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":262.28,"10th_percentile":262.28,"90th_percentile":262.28},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":133.88,"10th_percentile":133.88,"90th_percentile":133.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":393.5,"10th_percentile":387.01,"90th_percentile":471.06,"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","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":67.27,"10th_percentile":67.27,"90th_percentile":67.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":287.19,"10th_percentile":287.19,"90th_percentile":432.15,"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":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient 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":433.2,"10th_percentile":428.47,"90th_percentile":920.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"19","median_amount":1163.66,"10th_percentile":720.44,"90th_percentile":2899.19},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"13","median_amount":1022.56,"10th_percentile":720.44,"90th_percentile":1709.8},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"21","median_amount":458.09,"10th_percentile":422.56,"90th_percentile":1144.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"13","median_amount":809.04,"10th_percentile":809.04,"90th_percentile":1937.04,"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":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"36","median_amount":396.2,"10th_percentile":121.73,"90th_percentile":805.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":738.9,"10th_percentile":738.9,"90th_percentile":738.9},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":926.1,"10th_percentile":926.1,"90th_percentile":926.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":344.32,"10th_percentile":344.02,"90th_percentile":429.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":332.33,"10th_percentile":332.33,"90th_percentile":332.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":213.27,"10th_percentile":213.27,"90th_percentile":213.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":311.25,"10th_percentile":311.25,"90th_percentile":311.25},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":657.0,"10th_percentile":657.0,"90th_percentile":657.0,"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":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":620.01,"10th_percentile":620.01,"90th_percentile":620.01},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":294.18,"10th_percentile":294.18,"90th_percentile":294.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":226.14,"10th_percentile":226.14,"90th_percentile":226.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":289.22,"10th_percentile":289.22,"90th_percentile":289.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":374.01,"10th_percentile":374.01,"90th_percentile":374.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3850.0,"10th_percentile":3850.0,"90th_percentile":3850.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":1324.17,"10th_percentile":829.74,"90th_percentile":2599.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"15","median_amount":7051.68,"10th_percentile":5122.76,"90th_percentile":8124.87},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1155.72,"10th_percentile":630.96,"90th_percentile":1330.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":4633.06,"10th_percentile":1011.77,"90th_percentile":9909.37},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":415.1,"10th_percentile":355.31,"90th_percentile":1275.6,"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":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":473.04,"10th_percentile":473.04,"90th_percentile":473.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1332.0,"10th_percentile":524.26,"90th_percentile":6819.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":836.04,"10th_percentile":474.91,"90th_percentile":1381.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"60","median_amount":1017.54,"10th_percentile":509.4,"90th_percentile":1600.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1067.02,"10th_percentile":1067.02,"90th_percentile":1067.02,"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."}]}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":122.98,"10th_percentile":122.98,"90th_percentile":188.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":80.97,"10th_percentile":46.6,"90th_percentile":186.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":109.88,"10th_percentile":109.88,"90th_percentile":109.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":540.33,"10th_percentile":525.39,"90th_percentile":1168.64},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":52.9,"10th_percentile":52.9,"90th_percentile":52.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":585.98,"10th_percentile":585.98,"90th_percentile":585.98},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":109.88,"10th_percentile":109.88,"90th_percentile":113.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":629.04,"10th_percentile":564.01,"90th_percentile":638.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":569.7,"10th_percentile":569.7,"90th_percentile":569.7},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"12","median_amount":96.03,"10th_percentile":96.03,"90th_percentile":263.69,"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":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":96.03,"10th_percentile":96.03,"90th_percentile":96.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":251.1,"10th_percentile":251.1,"90th_percentile":251.1},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":54.35,"10th_percentile":54.35,"90th_percentile":54.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":660.6,"10th_percentile":251.1,"90th_percentile":1842.3},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":55.24,"10th_percentile":54.17,"90th_percentile":315.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":56.02,"10th_percentile":54.64,"90th_percentile":316.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":175.71,"10th_percentile":169.55,"90th_percentile":245.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":174.28,"10th_percentile":174.28,"90th_percentile":174.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":889.76,"10th_percentile":889.76,"90th_percentile":889.76},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":114.8,"10th_percentile":114.8,"90th_percentile":114.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":417.86,"10th_percentile":417.86,"90th_percentile":417.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":120.99,"10th_percentile":37.48,"90th_percentile":655.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":1697.4,"10th_percentile":1697.4,"90th_percentile":1697.4},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":121.83,"10th_percentile":121.83,"90th_percentile":121.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":119.87,"10th_percentile":119.87,"90th_percentile":119.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":121.83,"10th_percentile":121.83,"90th_percentile":121.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Electronic Analysis of Devices","code_information":[{"code":"5741","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":50.84,"10th_percentile":50.84,"90th_percentile":50.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":92.94,"10th_percentile":82.7,"90th_percentile":92.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"17","median_amount":174.3,"10th_percentile":174.3,"90th_percentile":174.3},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":33.21,"10th_percentile":33.21,"90th_percentile":33.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":174.3,"10th_percentile":174.3,"90th_percentile":195.88},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":187.11,"10th_percentile":187.11,"90th_percentile":187.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":72.29,"10th_percentile":72.29,"90th_percentile":81.23,"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","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":72.29,"10th_percentile":72.29,"90th_percentile":72.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":189.0,"10th_percentile":189.0,"90th_percentile":212.4},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":35.25,"10th_percentile":35.25,"90th_percentile":35.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":189.0,"10th_percentile":189.0,"90th_percentile":1197.9},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":34.69,"10th_percentile":33.47,"90th_percentile":35.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":34.55,"10th_percentile":34.55,"90th_percentile":34.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":171.63,"10th_percentile":171.63,"90th_percentile":171.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"342","median_amount":171.63,"10th_percentile":170.25,"90th_percentile":171.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"350","median_amount":210.82,"10th_percentile":190.82,"90th_percentile":210.82},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"89","median_amount":112.13,"10th_percentile":112.13,"90th_percentile":112.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"1 through 10","median_amount":94.49,"10th_percentile":94.49,"90th_percentile":94.49},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"78","median_amount":210.82,"10th_percentile":25.0,"90th_percentile":210.82},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":226.31,"10th_percentile":226.31,"90th_percentile":226.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"95","median_amount":116.92,"10th_percentile":115.98,"90th_percentile":116.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"102","median_amount":228.6,"10th_percentile":227.7,"90th_percentile":228.6},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"38","median_amount":116.62,"10th_percentile":112.54,"90th_percentile":116.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"62","median_amount":228.6,"10th_percentile":227.7,"90th_percentile":228.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"508","median_amount":117.08,"10th_percentile":115.68,"90th_percentile":117.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"569","median_amount":116.62,"10th_percentile":112.64,"90th_percentile":116.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"74","median_amount":119.0,"10th_percentile":117.12,"90th_percentile":119.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":275.3,"10th_percentile":275.3,"90th_percentile":275.3,"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":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental Procedures","code_information":[{"code":"5871","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":942.89,"10th_percentile":942.89,"90th_percentile":942.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"27","median_amount":2163.8,"10th_percentile":1884.92,"90th_percentile":2702.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Plate pheres leukoredu irrad","code_information":[{"code":"9530","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"1 through 10","median_amount":6225.0,"10th_percentile":6225.0,"90th_percentile":6225.0},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":342.24,"10th_percentile":86.97,"90th_percentile":1230.0},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":209.98,"10th_percentile":209.98,"90th_percentile":209.98},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"474","median_amount":47.59,"10th_percentile":15.84,"90th_percentile":164.46,"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":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"130","median_amount":90.13,"10th_percentile":15.56,"90th_percentile":263.08,"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":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":110.79,"10th_percentile":110.79,"90th_percentile":121.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"332","median_amount":415.0,"10th_percentile":127.82,"90th_percentile":982.72},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"85","median_amount":27.42,"10th_percentile":8.89,"90th_percentile":68.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"1 through 10","median_amount":1121.0,"10th_percentile":1121.0,"90th_percentile":1121.0},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"107","median_amount":339.47,"10th_percentile":95.45,"90th_percentile":1270.44},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"95","median_amount":41.43,"10th_percentile":7.37,"90th_percentile":172.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":68.35,"10th_percentile":68.35,"90th_percentile":68.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"46","median_amount":357.29,"10th_percentile":140.78,"90th_percentile":918.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":35.35,"10th_percentile":8.8,"90th_percentile":74.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":610.88,"10th_percentile":610.88,"90th_percentile":610.88},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"1 through 10","median_amount":350.1,"10th_percentile":350.1,"90th_percentile":350.1,"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","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"293","median_amount":51.52,"10th_percentile":11.19,"90th_percentile":179.17,"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":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":29.89,"10th_percentile":13.65,"90th_percentile":357.22,"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":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"1 through 10","median_amount":1809.9,"10th_percentile":1809.9,"90th_percentile":1809.9},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"111","median_amount":387.0,"10th_percentile":64.7,"90th_percentile":939.6},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"56","median_amount":32.35,"10th_percentile":8.63,"90th_percentile":94.15,"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":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"69","median_amount":334.8,"10th_percentile":25.53,"90th_percentile":1577.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"430","median_amount":32.35,"10th_percentile":8.63,"90th_percentile":107.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"473","median_amount":33.54,"10th_percentile":9.65,"90th_percentile":97.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"45","median_amount":42.08,"10th_percentile":18.71,"90th_percentile":75.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":850.08,"10th_percentile":850.08,"90th_percentile":850.08},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"52","median_amount":354.63,"10th_percentile":139.02,"90th_percentile":743.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":109.49,"10th_percentile":109.49,"90th_percentile":109.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"16","median_amount":852.0,"10th_percentile":366.86,"90th_percentile":1752.13},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":332.01,"10th_percentile":243.59,"90th_percentile":671.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"21","median_amount":125.63,"10th_percentile":103.97,"90th_percentile":212.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":1227.5,"10th_percentile":1227.5,"90th_percentile":1227.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":784.12,"10th_percentile":784.12,"90th_percentile":784.12,"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":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":95.69,"10th_percentile":95.69,"90th_percentile":112.9,"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","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":169.5,"10th_percentile":88.37,"90th_percentile":582.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"25","median_amount":876.6,"10th_percentile":237.6,"90th_percentile":1776.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"102","median_amount":393.53,"10th_percentile":129.32,"90th_percentile":783.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"39","median_amount":374.9,"10th_percentile":101.12,"90th_percentile":679.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":320.31,"10th_percentile":96.39,"90th_percentile":614.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"1 through 10","median_amount":277.84,"10th_percentile":277.84,"90th_percentile":277.84},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"277","median_amount":149.63,"10th_percentile":149.63,"90th_percentile":153.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"274","median_amount":250.66,"10th_percentile":250.66,"90th_percentile":250.66},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"47","median_amount":97.76,"10th_percentile":97.76,"90th_percentile":97.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"1 through 10","median_amount":250.66,"10th_percentile":250.66,"90th_percentile":250.66},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"174","median_amount":250.66,"10th_percentile":250.66,"90th_percentile":250.66},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":118.93,"10th_percentile":118.93,"90th_percentile":163.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"35","median_amount":269.08,"10th_percentile":269.08,"90th_percentile":269.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":101.66,"10th_percentile":101.66,"90th_percentile":104.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":271.8,"10th_percentile":271.8,"90th_percentile":271.8},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":174.8,"10th_percentile":174.8,"90th_percentile":277.84},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"1 through 10","median_amount":271.8,"10th_percentile":271.8,"90th_percentile":271.8,"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":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"12","median_amount":103.94,"10th_percentile":103.94,"90th_percentile":103.94,"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":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"44","median_amount":271.8,"10th_percentile":241.6,"90th_percentile":293.4},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":101.68,"10th_percentile":90.41,"90th_percentile":104.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"58","median_amount":271.8,"10th_percentile":271.8,"90th_percentile":293.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"172","median_amount":101.68,"10th_percentile":101.68,"90th_percentile":104.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"157","median_amount":101.68,"10th_percentile":101.68,"90th_percentile":104.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":103.74,"10th_percentile":103.74,"90th_percentile":120.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":387.13,"10th_percentile":387.13,"90th_percentile":433.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"41","median_amount":107.11,"10th_percentile":98.83,"90th_percentile":139.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"1 through 10","median_amount":754.32,"10th_percentile":754.32,"90th_percentile":754.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"37","median_amount":100.85,"10th_percentile":93.62,"90th_percentile":103.95,"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":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"18","median_amount":1386.9,"10th_percentile":846.9,"90th_percentile":2413.8},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8.25,"10th_percentile":8.25,"90th_percentile":8.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: 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":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6.66,"10th_percentile":6.66,"90th_percentile":6.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":92.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":30.72,"10th_percentile":30.72,"90th_percentile":30.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","methodology":"percent of total billed charges","standard_charge_percentage":41.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":83.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.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":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 90] [Observation (%BC): 90] [Emergency Department (%BC): 90] [Clinic Visit ($): 25] [Occupational Therapy (%BC): 90] [Physical Therapy (%BC): 90] [Respiratory Services/Therapy  (%BC): 90] [Speech Therapy (%BC): 90] [All Other OP (%BC): 90]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthEZ","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","methodology":"other","standard_charge_algorithm":"[Observation ($): 625] [Clinic Visit ($): 75] [Mental Health-Intensive ($): 275] [Mental Health-Partial Hospitalization ($): 350]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","methodology":"percent of total billed charges","standard_charge_percentage":75.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Taylor Benefit Resources","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]}],"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":"Ambetter","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial 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":"Taylor Benefit Resources","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliant Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthEZ","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"Ambetter","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial 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":"Taylor Benefit Resources","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliant Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthEZ","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Ambetter","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial 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":"Taylor Benefit Resources","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliant Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthEZ","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Ambetter","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial 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":"Taylor Benefit Resources","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliant Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthEZ","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Ambetter","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial 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":"Taylor Benefit Resources","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliant Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthEZ","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Reduced Services","code":"52","modifier_payer_information":[{"payer_name":"Ambetter","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial 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":"Taylor Benefit Resources","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliant Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthEZ","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Repeat Clinical Diagnostic Laboratory Test","code":"91","modifier_payer_information":[{"payer_name":"Ambetter","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial 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":"Taylor Benefit Resources","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliant Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthEZ","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Crna service: without medical direction by a physician","code":"QZ","modifier_payer_information":[{"payer_name":"Ambetter","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial 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":"Taylor Benefit Resources","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliant Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthEZ","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Distinct Procedural Service","code":"59","modifier_payer_information":[{"payer_name":"Ambetter","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial 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":"Taylor Benefit Resources","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliant Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthEZ","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","description":"The modified price is presented in the standard charge value."}]},{"description":"Item or service expected to be denied as not reasonable and necessary","code":"GZ","modifier_payer_information":[{"payer_name":"Ambetter","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"CMO Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - D-SNP","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Pathway Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"SHBP Other Commercial 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":"Taylor Benefit Resources","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliant Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Alliant Health","plan_name":"Solo Care Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerigroup","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Diversified Benefits Admin","plan_name":"City of Pelham Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Diversified Benefits Admin","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthEZ","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum Health","plan_name":"Behavioral Health Plan - PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State","plan_name":"Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Taylor Benefit Resources","plan_name":"Colquitt Regional PPO","description":"The modified price is presented in the standard charge value."}]}]}