{"hospital_name":"Adventhealth Wauchula","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Adventhealth Wauchula"],"hospital_address":["735 S 5Th Ave, Wauchula, FL 33873"],"license_information":{"license_number":"4239","state":"FL"},"type_2_npi":["1275511651","1457458986"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Tim Reiner "},"standard_charge_information":[{"description":"XYLOCAINE/EPINEPHRINE 1 %-1:100000 IJ 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Type: Pharmacy | NDC EA = 5 GR"}]},{"description":"GNP TRIPLE ANTIBIOTIC EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122041405","type":"NDC"}],"standard_charges":[{"gross_charge":43.88,"discounted_cash":43.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.2 GR"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 200 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"71286601102","type":"NDC"}],"standard_charges":[{"gross_charge":54.71,"discounted_cash":54.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ 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Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DEXTROMETHORPHAN POLISTIREX ER 30 MG/5ML PO SUER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802043321","type":"NDC"}],"standard_charges":[{"gross_charge":26.28,"discounted_cash":26.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904698516","type":"NDC"}],"standard_charges":[{"gross_charge":3.94,"discounted_cash":3.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.333 ML"}]},{"description":"TRUEPLUS GLUCOSE 15 GM/32ML PO 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GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00067815203","type":"NDC"}],"standard_charges":[{"gross_charge":12.4,"discounted_cash":12.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 GR"}]},{"description":"NYSTOP 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00574200830","type":"NDC"}],"standard_charges":[{"gross_charge":167.45,"discounted_cash":167.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"NYSTOP 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00574200802","type":"NDC"}],"standard_charges":[{"gross_charge":159.01,"discounted_cash":159.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 GR"}]},{"description":"PROCTOZONE-HC 2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"64980032430","type":"NDC"}],"standard_charges":[{"gross_charge":148.4,"discounted_cash":148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"59762013102","type":"NDC"}],"standard_charges":[{"gross_charge":175.58,"discounted_cash":175.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 GR"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"67877047379","type":"NDC"}],"standard_charges":[{"gross_charge":171.87,"discounted_cash":171.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35.44 GR"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"gross_charge":134.74,"discounted_cash":134.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 GR"}]},{"description":"CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00168025815","type":"NDC"}],"standard_charges":[{"gross_charge":216.6,"discounted_cash":216.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60505082901","type":"NDC"}],"standard_charges":[{"gross_charge":160.54,"discounted_cash":160.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 GR"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054327099","type":"NDC"}],"standard_charges":[{"gross_charge":217.44,"discounted_cash":217.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 GR"}]},{"description":"LIDOCAINE 4 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"39328002455","type":"NDC"}],"standard_charges":[{"gross_charge":68.27,"discounted_cash":68.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 GR"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68462018117","type":"NDC"}],"standard_charges":[{"gross_charge":244.03,"discounted_cash":244.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536118365","type":"NDC"}],"standard_charges":[{"gross_charge":151.54,"discounted_cash":151.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15.8 GR"}]},{"description":"ZINC OXIDE 20 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"75834017001","type":"NDC"}],"standard_charges":[{"gross_charge":124.77,"discounted_cash":124.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00713065615","type":"NDC"}],"standard_charges":[{"gross_charge":85.92,"discounted_cash":85.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802006535","type":"NDC"}],"standard_charges":[{"gross_charge":91.63,"discounted_cash":91.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"NYSTATIN 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68382037001","type":"NDC"}],"standard_charges":[{"gross_charge":165.55,"discounted_cash":165.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"FLUOCINONIDE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672138601","type":"NDC"}],"standard_charges":[{"gross_charge":204.03,"discounted_cash":204.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"GENTAMICIN SULFATE 0.1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00713068215","type":"NDC"}],"standard_charges":[{"gross_charge":153.62,"discounted_cash":153.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"BACITRACIN-POLYMYXIN B 500-10000 UNIT/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208055555","type":"NDC"}],"standard_charges":[{"gross_charge":154.79,"discounted_cash":154.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14674.59,"maximum":27221.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24605.65},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":15826.49},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":19145.52},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":14674.59},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21841.24},{"payer_name":"Bcbs","plan_name":"Ppc Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27221.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"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":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17229.61,"maximum":31961.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28889.77},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":18582.06},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":22478.97},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":17229.61},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25644.05},{"payer_name":"Bcbs","plan_name":"Ppc Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31961.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"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":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21264.05,"maximum":39445.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35654.54},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":22933.2},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":27742.6},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21264.05},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31648.8},{"payer_name":"Bcbs","plan_name":"Ppc Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39445.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23547.13,"maximum":43680.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39482.69},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":25395.49},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":30721.26},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23547.13},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35046.86},{"payer_name":"Bcbs","plan_name":"Ppc Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43680.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"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":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16427.99,"maximum":30474.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27545.67},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17717.53},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":21433.13},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":16427.99},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24450.95},{"payer_name":"Bcbs","plan_name":"Ppc Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30474.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"1 through 10","median_amount":2616.16,"10th_percentile":2616.16,"90th_percentile":2616.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27285.28,"maximum":50615.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45750.65},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":29427.07},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":35598.33},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":27285.28},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40610.62},{"payer_name":"Bcbs","plan_name":"Ppc Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50615.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","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","minimum":15863.82,"maximum":29427.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26599.69},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":17109.07},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":20697.07},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":15863.82},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23611.25},{"payer_name":"Bcbs","plan_name":"Ppc Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29427.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23212.28,"maximum":43059.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38921.23},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":25034.35},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":30284.39},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":23212.28},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34548.48},{"payer_name":"Bcbs","plan_name":"Ppc Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43059.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21872.87,"maximum":40574.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36675.38},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":23589.81},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":28536.91},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":21872.87},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32554.95},{"payer_name":"Bcbs","plan_name":"Ppc Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40574.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"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":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":85165.8,"maximum":157985.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":142801.9},{"payer_name":"Bcbs","plan_name":"Blue Select Ppo","methodology":"fee schedule","standard_charge_dollar":91850.98},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"fee schedule","standard_charge_dollar":111113.38},{"payer_name":"Bcbs","plan_name":"My Blue Hmo","methodology":"fee schedule","standard_charge_dollar":85165.8},{"payer_name":"Bcbs","plan_name":"Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":126758.3},{"payer_name":"Bcbs","plan_name":"Ppc Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":157985.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"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":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O Cc/Mcc","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Cc","code_information":[{"code":"339","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Mcc","code_information":[{"code":"341","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Cc","code_information":[{"code":"342","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"343","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, female reproductive system w CC","code_information":[{"code":"366","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","code_information":[{"code":"490","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"527","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Proc w Pdx Hemorrhage","code_information":[{"code":"528","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular shunt procedures w CC","code_information":[{"code":"529","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures w/o CC","code_information":[{"code":"530","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w CC","code_information":[{"code":"531","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedure Unrelated To Principal Diagnosis W Cc","code_information":[{"code":"985","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1872] [Swing Bed-Per Diem: 1693.12]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 232136 | Total % of Charge: 51.02] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Swing Bed-Per Diem: 1739] [IP Prosthetics/Implants/Devices (%BC): 16.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 1934] [Swing Bed-Per Diem: 1743]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":65.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1890] [Swing Bed-Per Diem: 1709.40]","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":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.8] [Cardiac Cath (%BC): 71.8] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 71.8] [Occupational Therapy (%BC): 71.8] [Physical Therapy (%BC): 71.8] [Respiratory Services/Therapy  (%BC): 71.8] [Speech Therapy (%BC): 71.8] [All Other OP (%BC): 71.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.22] [Cardiac Cath (%BC): 49.22] [Lithotripsy (%BC): 49.22] [PTCA (%BC): 49.22] [Observation (%BC): 58.33] [Emergency Department (%BC): 58.33] [Other Cardiac Testing (%BC): 55.70] [EEG (%BC): 55.70] [Chemotherapy (%BC): 55.70] [Nuclear Medicine (%BC): 13.65] [Radiation Therapy  (%BC): 55.70] [CT OP Scan (%BC): 13.65] [MRI OP (%BC): 13.65] [Positron Emission Tomography (%BC): 13.65] [Radiology (%BC): 13.65] [Laboratory (%BC): 55.70] [Occupational Therapy (%BC): 55.70] [Physical Therapy (%BC): 55.70] [Respiratory Services/Therapy  (%BC): 55.70] [Speech Therapy (%BC): 55.70] [Other Outpatient Implant (%BC): 16.69] [IV Therapy (%BC): 55.70] [All Other OP (%BC): 55.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.33,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":131.93,"10th_percentile":131.93,"90th_percentile":131.93,"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":"Sunshine Health","plan_name":"Ambetter Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"1 through 10","median_amount":153.83,"10th_percentile":153.83,"90th_percentile":153.83},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":139.4,"10th_percentile":139.4,"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":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":66.64,"count":"1 through 10","median_amount":1227.47,"10th_percentile":1227.47,"90th_percentile":1227.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.5,"count":"1 through 10","median_amount":72.76,"10th_percentile":72.76,"90th_percentile":72.76},{"payer_name":"Wellpoint","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.8] [Cardiac Cath (%BC): 71.8] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 71.8] [Occupational Therapy (%BC): 71.8] [Physical Therapy (%BC): 71.8] [Respiratory Services/Therapy  (%BC): 71.8] [Speech Therapy (%BC): 71.8] [All Other OP (%BC): 71.8]","count":"1 through 10","median_amount":588.82,"10th_percentile":423.27,"90th_percentile":1780.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.22] [Cardiac Cath (%BC): 49.22] [Lithotripsy (%BC): 49.22] [PTCA (%BC): 49.22] [Observation (%BC): 58.33] [Emergency Department (%BC): 58.33] [Other Cardiac Testing (%BC): 55.70] [EEG (%BC): 55.70] [Chemotherapy (%BC): 55.70] [Nuclear Medicine (%BC): 13.65] [Radiation Therapy  (%BC): 55.70] [CT OP Scan (%BC): 13.65] [MRI OP (%BC): 13.65] [Positron Emission Tomography (%BC): 13.65] [Radiology (%BC): 13.65] [Laboratory (%BC): 55.70] [Occupational Therapy (%BC): 55.70] [Physical Therapy (%BC): 55.70] [Respiratory Services/Therapy  (%BC): 55.70] [Speech Therapy (%BC): 55.70] [Other Outpatient Implant (%BC): 16.69] [IV Therapy (%BC): 55.70] [All Other OP (%BC): 55.70]","count":"1 through 10","median_amount":484.6,"10th_percentile":445.15,"90th_percentile":612.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.33,"count":"1 through 10","median_amount":535.32,"10th_percentile":535.32,"90th_percentile":535.32},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.2,"count":"1 through 10","median_amount":718.13,"10th_percentile":718.13,"90th_percentile":718.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":172.09,"10th_percentile":172.09,"90th_percentile":172.09,"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":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"14","median_amount":177.45,"10th_percentile":158.59,"90th_percentile":284.72,"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":"Sunshine Health","plan_name":"Ambetter Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"1 through 10","median_amount":232.28,"10th_percentile":232.28,"90th_percentile":977.06},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"27","median_amount":187.5,"10th_percentile":132.42,"90th_percentile":407.39,"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":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":66.64,"count":"1 through 10","median_amount":951.17,"10th_percentile":951.17,"90th_percentile":951.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":111.28,"10th_percentile":111.28,"90th_percentile":111.28,"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":"percent of total billed charges","standard_charge_percentage":10.5,"count":"1 through 10","median_amount":109.86,"10th_percentile":109.86,"90th_percentile":160.67},{"payer_name":"Wellpoint","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.8] [Cardiac Cath (%BC): 71.8] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 71.8] [Occupational Therapy (%BC): 71.8] [Physical Therapy (%BC): 71.8] [Respiratory Services/Therapy  (%BC): 71.8] [Speech Therapy (%BC): 71.8] [All Other OP (%BC): 71.8]","count":"1 through 10","median_amount":1205.76,"10th_percentile":818.49,"90th_percentile":3930.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.4,"count":"1 through 10","median_amount":455.7,"10th_percentile":455.7,"90th_percentile":455.7},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.22] [Cardiac Cath (%BC): 49.22] [Lithotripsy (%BC): 49.22] [PTCA (%BC): 49.22] [Observation (%BC): 58.33] [Emergency Department (%BC): 58.33] [Other Cardiac Testing (%BC): 55.70] [EEG (%BC): 55.70] [Chemotherapy (%BC): 55.70] [Nuclear Medicine (%BC): 13.65] [Radiation Therapy  (%BC): 55.70] [CT OP Scan (%BC): 13.65] [MRI OP (%BC): 13.65] [Positron Emission Tomography (%BC): 13.65] [Radiology (%BC): 13.65] [Laboratory (%BC): 55.70] [Occupational Therapy (%BC): 55.70] [Physical Therapy (%BC): 55.70] [Respiratory Services/Therapy  (%BC): 55.70] [Speech Therapy (%BC): 55.70] [Other Outpatient Implant (%BC): 16.69] [IV Therapy (%BC): 55.70] [All Other OP (%BC): 55.70]","count":"20","median_amount":1712.77,"10th_percentile":865.51,"90th_percentile":3103.09,"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":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.33,"count":"1 through 10","median_amount":18.16,"10th_percentile":18.16,"90th_percentile":18.16},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.2,"count":"1 through 10","median_amount":2111.28,"10th_percentile":1883.83,"90th_percentile":2871.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"1 through 10","median_amount":303.19,"10th_percentile":303.19,"90th_percentile":303.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"45","median_amount":188.3,"10th_percentile":162.64,"90th_percentile":313.15,"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":"Sunshine Health","plan_name":"Ambetter Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"22","median_amount":712.85,"10th_percentile":362.74,"90th_percentile":872.04},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"131","median_amount":198.96,"10th_percentile":177.56,"90th_percentile":323.8,"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":66.64,"count":"11","median_amount":883.99,"10th_percentile":798.29,"90th_percentile":2101.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"24","median_amount":230.72,"10th_percentile":201.14,"90th_percentile":333.84,"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":"percent of total billed charges","standard_charge_percentage":10.5,"count":"30","median_amount":186.8,"10th_percentile":124.17,"90th_percentile":371.63},{"payer_name":"Wellpoint","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.8] [Cardiac Cath (%BC): 71.8] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 71.8] [Occupational Therapy (%BC): 71.8] [Physical Therapy (%BC): 71.8] [Respiratory Services/Therapy  (%BC): 71.8] [Speech Therapy (%BC): 71.8] [All Other OP (%BC): 71.8]","count":"11","median_amount":3249.23,"10th_percentile":1432.13,"90th_percentile":6739.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.4,"count":"1 through 10","median_amount":1843.98,"10th_percentile":1843.98,"90th_percentile":1843.98},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.22] [Cardiac Cath (%BC): 49.22] [Lithotripsy (%BC): 49.22] [PTCA (%BC): 49.22] [Observation (%BC): 58.33] [Emergency Department (%BC): 58.33] [Other Cardiac Testing (%BC): 55.70] [EEG (%BC): 55.70] [Chemotherapy (%BC): 55.70] [Nuclear Medicine (%BC): 13.65] [Radiation Therapy  (%BC): 55.70] [CT OP Scan (%BC): 13.65] [MRI OP (%BC): 13.65] [Positron Emission Tomography (%BC): 13.65] [Radiology (%BC): 13.65] [Laboratory (%BC): 55.70] [Occupational Therapy (%BC): 55.70] [Physical Therapy (%BC): 55.70] [Respiratory Services/Therapy  (%BC): 55.70] [Speech Therapy (%BC): 55.70] [Other Outpatient Implant (%BC): 16.69] [IV Therapy (%BC): 55.70] [All Other OP (%BC): 55.70]","count":"40","median_amount":3179.05,"10th_percentile":1965.48,"90th_percentile":10550.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.33,"count":"1 through 10","median_amount":527.78,"10th_percentile":527.78,"90th_percentile":1730.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.2,"count":"1 through 10","median_amount":5264.44,"10th_percentile":3073.44,"90th_percentile":12879.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":920.4,"10th_percentile":881.75,"90th_percentile":1004.73,"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":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"28","median_amount":416.02,"10th_percentile":177.45,"90th_percentile":984.07,"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":"Sunshine Health","plan_name":"Ambetter Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"42","median_amount":1300.96,"10th_percentile":759.06,"90th_percentile":4011.44},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"93","median_amount":350.97,"10th_percentile":187.5,"90th_percentile":853.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":66.64,"count":"12","median_amount":2564.72,"10th_percentile":1829.25,"90th_percentile":9587.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":464.54,"10th_percentile":358.56,"90th_percentile":556.4,"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":"percent of total billed charges","standard_charge_percentage":10.5,"count":"45","median_amount":554.47,"10th_percentile":308.76,"90th_percentile":1940.61},{"payer_name":"Wellpoint","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.8] [Cardiac Cath (%BC): 71.8] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 71.8] [Occupational Therapy (%BC): 71.8] [Physical Therapy (%BC): 71.8] [Respiratory Services/Therapy  (%BC): 71.8] [Speech Therapy (%BC): 71.8] [All Other OP (%BC): 71.8]","count":"16","median_amount":6840.62,"10th_percentile":2254.69,"90th_percentile":16147.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.4,"count":"1 through 10","median_amount":1786.27,"10th_percentile":1427.25,"90th_percentile":2767.24},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.22] [Cardiac Cath (%BC): 49.22] [Lithotripsy (%BC): 49.22] [PTCA (%BC): 49.22] [Observation (%BC): 58.33] [Emergency Department (%BC): 58.33] [Other Cardiac Testing (%BC): 55.70] [EEG (%BC): 55.70] [Chemotherapy (%BC): 55.70] [Nuclear Medicine (%BC): 13.65] [Radiation Therapy  (%BC): 55.70] [CT OP Scan (%BC): 13.65] [MRI OP (%BC): 13.65] [Positron Emission Tomography (%BC): 13.65] [Radiology (%BC): 13.65] [Laboratory (%BC): 55.70] [Occupational Therapy (%BC): 55.70] [Physical Therapy (%BC): 55.70] [Respiratory Services/Therapy  (%BC): 55.70] [Speech Therapy (%BC): 55.70] [Other Outpatient Implant (%BC): 16.69] [IV Therapy (%BC): 55.70] [All Other OP (%BC): 55.70]","count":"16","median_amount":7619.4,"10th_percentile":4589.56,"90th_percentile":13289.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.33,"count":"1 through 10","median_amount":1088.03,"10th_percentile":1088.03,"90th_percentile":1608.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.2,"count":"1 through 10","median_amount":14236.32,"10th_percentile":5821.3,"90th_percentile":25140.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"17","median_amount":741.33,"10th_percentile":179.08,"90th_percentile":1365.67,"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":"Sunshine Health","plan_name":"Ambetter Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"22","median_amount":3454.95,"10th_percentile":1775.46,"90th_percentile":5260.25},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"31","median_amount":608.96,"10th_percentile":229.35,"90th_percentile":1174.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":66.64,"count":"1 through 10","median_amount":11077.71,"10th_percentile":4142.47,"90th_percentile":22661.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":486.87,"10th_percentile":482.93,"90th_percentile":690.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.5,"count":"74","median_amount":1345.89,"10th_percentile":695.16,"90th_percentile":2573.13},{"payer_name":"Wellpoint","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.8] [Cardiac Cath (%BC): 71.8] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 71.8] [Occupational Therapy (%BC): 71.8] [Physical Therapy (%BC): 71.8] [Respiratory Services/Therapy  (%BC): 71.8] [Speech Therapy (%BC): 71.8] [All Other OP (%BC): 71.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.22] [Cardiac Cath (%BC): 49.22] [Lithotripsy (%BC): 49.22] [PTCA (%BC): 49.22] [Observation (%BC): 58.33] [Emergency Department (%BC): 58.33] [Other Cardiac Testing (%BC): 55.70] [EEG (%BC): 55.70] [Chemotherapy (%BC): 55.70] [Nuclear Medicine (%BC): 13.65] [Radiation Therapy  (%BC): 55.70] [CT OP Scan (%BC): 13.65] [MRI OP (%BC): 13.65] [Positron Emission Tomography (%BC): 13.65] [Radiology (%BC): 13.65] [Laboratory (%BC): 55.70] [Occupational Therapy (%BC): 55.70] [Physical Therapy (%BC): 55.70] [Respiratory Services/Therapy  (%BC): 55.70] [Speech Therapy (%BC): 55.70] [Other Outpatient Implant (%BC): 16.69] [IV Therapy (%BC): 55.70] [All Other OP (%BC): 55.70]","count":"1 through 10","median_amount":22204.74,"10th_percentile":22204.74,"90th_percentile":22204.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.33,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":687.27,"10th_percentile":687.27,"90th_percentile":687.27,"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":"Sunshine Health","plan_name":"Ambetter Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"1 through 10","median_amount":5640.3,"10th_percentile":5640.3,"90th_percentile":5640.3},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1233.87,"10th_percentile":1233.87,"90th_percentile":1233.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":66.64,"count":"1 through 10","median_amount":11902.8,"10th_percentile":11902.8,"90th_percentile":11902.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.5,"count":"1 through 10","median_amount":1848.18,"10th_percentile":1107.65,"90th_percentile":5668.35},{"payer_name":"Wellpoint","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"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":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.8] [Cardiac Cath (%BC): 71.8] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 71.8] [Occupational Therapy (%BC): 71.8] [Physical Therapy (%BC): 71.8] [Respiratory Services/Therapy  (%BC): 71.8] [Speech Therapy (%BC): 71.8] [All Other OP (%BC): 71.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.22] [Cardiac Cath (%BC): 49.22] [Lithotripsy (%BC): 49.22] [PTCA (%BC): 49.22] [Observation (%BC): 58.33] [Emergency Department (%BC): 58.33] [Other Cardiac Testing (%BC): 55.70] [EEG (%BC): 55.70] [Chemotherapy (%BC): 55.70] [Nuclear Medicine (%BC): 13.65] [Radiation Therapy  (%BC): 55.70] [CT OP Scan (%BC): 13.65] [MRI OP (%BC): 13.65] [Positron Emission Tomography (%BC): 13.65] [Radiology (%BC): 13.65] [Laboratory (%BC): 55.70] [Occupational Therapy (%BC): 55.70] [Physical Therapy (%BC): 55.70] [Respiratory Services/Therapy  (%BC): 55.70] [Speech Therapy (%BC): 55.70] [Other Outpatient Implant (%BC): 16.69] [IV Therapy (%BC): 55.70] [All Other OP (%BC): 55.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.33,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Ambetter Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":632.99,"10th_percentile":632.99,"90th_percentile":632.99,"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":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":66.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.5,"count":"1 through 10","median_amount":820.09,"10th_percentile":820.09,"90th_percentile":820.09},{"payer_name":"Wellpoint","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.8] [Cardiac Cath (%BC): 71.8] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 71.8] [Occupational Therapy (%BC): 71.8] [Physical Therapy (%BC): 71.8] [Respiratory Services/Therapy  (%BC): 71.8] [Speech Therapy (%BC): 71.8] [All Other OP (%BC): 71.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.22] [Cardiac Cath (%BC): 49.22] [Lithotripsy (%BC): 49.22] [PTCA (%BC): 49.22] [Observation (%BC): 58.33] [Emergency Department (%BC): 58.33] [Other Cardiac Testing (%BC): 55.70] [EEG (%BC): 55.70] [Chemotherapy (%BC): 55.70] [Nuclear Medicine (%BC): 13.65] [Radiation Therapy  (%BC): 55.70] [CT OP Scan (%BC): 13.65] [MRI OP (%BC): 13.65] [Positron Emission Tomography (%BC): 13.65] [Radiology (%BC): 13.65] [Laboratory (%BC): 55.70] [Occupational Therapy (%BC): 55.70] [Physical Therapy (%BC): 55.70] [Respiratory Services/Therapy  (%BC): 55.70] [Speech Therapy (%BC): 55.70] [Other Outpatient Implant (%BC): 16.69] [IV Therapy (%BC): 55.70] [All Other OP (%BC): 55.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.33,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Ambetter Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"1 through 10","median_amount":3944.04,"10th_percentile":3944.04,"90th_percentile":3944.04},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":66.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellpoint","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"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":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.8] [Cardiac Cath (%BC): 71.8] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 71.8] [Occupational Therapy (%BC): 71.8] [Physical Therapy (%BC): 71.8] [Respiratory Services/Therapy  (%BC): 71.8] [Speech Therapy (%BC): 71.8] [All Other OP (%BC): 71.8]","count":"1 through 10","median_amount":119.68,"10th_percentile":119.68,"90th_percentile":345.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.4,"count":"1 through 10","median_amount":110.35,"10th_percentile":110.35,"90th_percentile":110.35},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.22] [Cardiac Cath (%BC): 49.22] [Lithotripsy (%BC): 49.22] [PTCA (%BC): 49.22] [Observation (%BC): 58.33] [Emergency Department (%BC): 58.33] [Other Cardiac Testing (%BC): 55.70] [EEG (%BC): 55.70] [Chemotherapy (%BC): 55.70] [Nuclear Medicine (%BC): 13.65] [Radiation Therapy  (%BC): 55.70] [CT OP Scan (%BC): 13.65] [MRI OP (%BC): 13.65] [Positron Emission Tomography (%BC): 13.65] [Radiology (%BC): 13.65] [Laboratory (%BC): 55.70] [Occupational Therapy (%BC): 55.70] [Physical Therapy (%BC): 55.70] [Respiratory Services/Therapy  (%BC): 55.70] [Speech Therapy (%BC): 55.70] [Other Outpatient Implant (%BC): 16.69] [IV Therapy (%BC): 55.70] [All Other OP (%BC): 55.70]","count":"1 through 10","median_amount":152.8,"10th_percentile":152.8,"90th_percentile":464.36,"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":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.33,"count":"1 through 10","median_amount":103.51,"10th_percentile":103.51,"90th_percentile":103.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.2,"count":"1 through 10","median_amount":728.3,"10th_percentile":728.3,"90th_percentile":728.3},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.7,"count":"1 through 10","median_amount":166.28,"10th_percentile":166.28,"90th_percentile":166.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":79.53,"10th_percentile":57.56,"90th_percentile":123.68,"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":"Sunshine Health","plan_name":"Ambetter Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"1 through 10","median_amount":235.57,"10th_percentile":235.57,"90th_percentile":364.71},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"13","median_amount":57.02,"10th_percentile":57.02,"90th_percentile":85.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":66.64,"count":"1 through 10","median_amount":746.61,"10th_percentile":642.45,"90th_percentile":1790.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":117.58,"10th_percentile":117.58,"90th_percentile":117.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.5,"count":"26","median_amount":111.42,"10th_percentile":40.15,"90th_percentile":290.84},{"payer_name":"Wellpoint","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.8] [Cardiac Cath (%BC): 71.8] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 71.8] [Occupational Therapy (%BC): 71.8] [Physical Therapy (%BC): 71.8] [Respiratory Services/Therapy  (%BC): 71.8] [Speech Therapy (%BC): 71.8] [All Other OP (%BC): 71.8]","count":"15","median_amount":297.21,"10th_percentile":238.5,"90th_percentile":772.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.4,"count":"1 through 10","median_amount":331.67,"10th_percentile":242.39,"90th_percentile":427.81},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.22] [Cardiac Cath (%BC): 49.22] [Lithotripsy (%BC): 49.22] [PTCA (%BC): 49.22] [Observation (%BC): 58.33] [Emergency Department (%BC): 58.33] [Other Cardiac Testing (%BC): 55.70] [EEG (%BC): 55.70] [Chemotherapy (%BC): 55.70] [Nuclear Medicine (%BC): 13.65] [Radiation Therapy  (%BC): 55.70] [CT OP Scan (%BC): 13.65] [MRI OP (%BC): 13.65] [Positron Emission Tomography (%BC): 13.65] [Radiology (%BC): 13.65] [Laboratory (%BC): 55.70] [Occupational Therapy (%BC): 55.70] [Physical Therapy (%BC): 55.70] [Respiratory Services/Therapy  (%BC): 55.70] [Speech Therapy (%BC): 55.70] [Other Outpatient Implant (%BC): 16.69] [IV Therapy (%BC): 55.70] [All Other OP (%BC): 55.70]","count":"1 through 10","median_amount":490.7,"10th_percentile":307.23,"90th_percentile":1099.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.33,"count":"1 through 10","median_amount":488.46,"10th_percentile":482.3,"90th_percentile":1769.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.2,"count":"1 through 10","median_amount":1712.92,"10th_percentile":1604.52,"90th_percentile":4002.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"11","median_amount":101.59,"10th_percentile":86.34,"90th_percentile":112.92,"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":"Sunshine Health","plan_name":"Ambetter Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"13","median_amount":643.96,"10th_percentile":517.41,"90th_percentile":1052.79},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"23","median_amount":108.03,"10th_percentile":85.53,"90th_percentile":168.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":66.64,"count":"1 through 10","median_amount":1840.65,"10th_percentile":1212.55,"90th_percentile":4298.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":111.28,"10th_percentile":111.28,"90th_percentile":111.28,"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":"percent of total billed charges","standard_charge_percentage":10.5,"count":"47","median_amount":323.77,"10th_percentile":115.46,"90th_percentile":681.23},{"payer_name":"Wellpoint","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.8] [Cardiac Cath (%BC): 71.8] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 71.8] [Occupational Therapy (%BC): 71.8] [Physical Therapy (%BC): 71.8] [Respiratory Services/Therapy  (%BC): 71.8] [Speech Therapy (%BC): 71.8] [All Other OP (%BC): 71.8]","count":"1 through 10","median_amount":936.25,"10th_percentile":531.44,"90th_percentile":1748.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.4,"count":"1 through 10","median_amount":794.73,"10th_percentile":794.73,"90th_percentile":1371.13},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.22] [Cardiac Cath (%BC): 49.22] [Lithotripsy (%BC): 49.22] [PTCA (%BC): 49.22] [Observation (%BC): 58.33] [Emergency Department (%BC): 58.33] [Other Cardiac Testing (%BC): 55.70] [EEG (%BC): 55.70] [Chemotherapy (%BC): 55.70] [Nuclear Medicine (%BC): 13.65] [Radiation Therapy  (%BC): 55.70] [CT OP Scan (%BC): 13.65] [MRI OP (%BC): 13.65] [Positron Emission Tomography (%BC): 13.65] [Radiology (%BC): 13.65] [Laboratory (%BC): 55.70] [Occupational Therapy (%BC): 55.70] [Physical Therapy (%BC): 55.70] [Respiratory Services/Therapy  (%BC): 55.70] [Speech Therapy (%BC): 55.70] [Other Outpatient Implant (%BC): 16.69] [IV Therapy (%BC): 55.70] [All Other OP (%BC): 55.70]","count":"1 through 10","median_amount":1213.47,"10th_percentile":738.11,"90th_percentile":2440.25,"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":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.33,"count":"1 through 10","median_amount":1254.44,"10th_percentile":444.8,"90th_percentile":1286.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.0,"count":"1 through 10","median_amount":859.38,"10th_percentile":859.38,"90th_percentile":859.38},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":245.93,"10th_percentile":245.93,"90th_percentile":245.93,"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":"Sunshine Health","plan_name":"Ambetter Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"1 through 10","median_amount":1696.44,"10th_percentile":1586.63,"90th_percentile":3710.74},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":175.56,"10th_percentile":175.56,"90th_percentile":245.26,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":66.64,"count":"1 through 10","median_amount":7373.83,"10th_percentile":5580.0,"90th_percentile":10669.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":111.28,"10th_percentile":111.28,"90th_percentile":111.28,"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":"percent of total billed charges","standard_charge_percentage":10.5,"count":"25","median_amount":882.61,"10th_percentile":180.55,"90th_percentile":1278.79},{"payer_name":"Wellpoint","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.8] [Cardiac Cath (%BC): 71.8] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 71.8] [Occupational Therapy (%BC): 71.8] [Physical Therapy (%BC): 71.8] [Respiratory Services/Therapy  (%BC): 71.8] [Speech Therapy (%BC): 71.8] [All Other OP (%BC): 71.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.22] [Cardiac Cath (%BC): 49.22] [Lithotripsy (%BC): 49.22] [PTCA (%BC): 49.22] [Observation (%BC): 58.33] [Emergency Department (%BC): 58.33] [Other Cardiac Testing (%BC): 55.70] [EEG (%BC): 55.70] [Chemotherapy (%BC): 55.70] [Nuclear Medicine (%BC): 13.65] [Radiation Therapy  (%BC): 55.70] [CT OP Scan (%BC): 13.65] [MRI OP (%BC): 13.65] [Positron Emission Tomography (%BC): 13.65] [Radiology (%BC): 13.65] [Laboratory (%BC): 55.70] [Occupational Therapy (%BC): 55.70] [Physical Therapy (%BC): 55.70] [Respiratory Services/Therapy  (%BC): 55.70] [Speech Therapy (%BC): 55.70] [Other Outpatient Implant (%BC): 16.69] [IV Therapy (%BC): 55.70] [All Other OP (%BC): 55.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.33,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Ambetter Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":66.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.5,"count":"1 through 10","median_amount":424.5,"10th_percentile":424.5,"90th_percentile":424.5},{"payer_name":"Wellpoint","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"1 through 10","median_amount":815.92,"10th_percentile":815.92,"90th_percentile":815.92}]}]},{"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":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.8] [Cardiac Cath (%BC): 71.8] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 71.8] [Occupational Therapy (%BC): 71.8] [Physical Therapy (%BC): 71.8] [Respiratory Services/Therapy  (%BC): 71.8] [Speech Therapy (%BC): 71.8] [All Other OP (%BC): 71.8]","count":"1 through 10","median_amount":2646.18,"10th_percentile":2646.18,"90th_percentile":2646.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.22] [Cardiac Cath (%BC): 49.22] [Lithotripsy (%BC): 49.22] [PTCA (%BC): 49.22] [Observation (%BC): 58.33] [Emergency Department (%BC): 58.33] [Other Cardiac Testing (%BC): 55.70] [EEG (%BC): 55.70] [Chemotherapy (%BC): 55.70] [Nuclear Medicine (%BC): 13.65] [Radiation Therapy  (%BC): 55.70] [CT OP Scan (%BC): 13.65] [MRI OP (%BC): 13.65] [Positron Emission Tomography (%BC): 13.65] [Radiology (%BC): 13.65] [Laboratory (%BC): 55.70] [Occupational Therapy (%BC): 55.70] [Physical Therapy (%BC): 55.70] [Respiratory Services/Therapy  (%BC): 55.70] [Speech Therapy (%BC): 55.70] [Other Outpatient Implant (%BC): 16.69] [IV Therapy (%BC): 55.70] [All Other OP (%BC): 55.70]","count":"1 through 10","median_amount":2075.07,"10th_percentile":2075.07,"90th_percentile":2075.07,"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":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.33,"count":"1 through 10","median_amount":813.52,"10th_percentile":813.52,"90th_percentile":838.78},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Ambetter Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":38.52,"10th_percentile":38.52,"90th_percentile":38.52,"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":66.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":222.56,"10th_percentile":222.56,"90th_percentile":222.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.5,"count":"1 through 10","median_amount":777.18,"10th_percentile":777.18,"90th_percentile":777.18},{"payer_name":"Wellpoint","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.8] [Cardiac Cath (%BC): 71.8] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 71.8] [Occupational Therapy (%BC): 71.8] [Physical Therapy (%BC): 71.8] [Respiratory Services/Therapy  (%BC): 71.8] [Speech Therapy (%BC): 71.8] [All Other OP (%BC): 71.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.4,"count":"1 through 10","median_amount":1411.66,"10th_percentile":1041.28,"90th_percentile":1575.14},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.22] [Cardiac Cath (%BC): 49.22] [Lithotripsy (%BC): 49.22] [PTCA (%BC): 49.22] [Observation (%BC): 58.33] [Emergency Department (%BC): 58.33] [Other Cardiac Testing (%BC): 55.70] [EEG (%BC): 55.70] [Chemotherapy (%BC): 55.70] [Nuclear Medicine (%BC): 13.65] [Radiation Therapy  (%BC): 55.70] [CT OP Scan (%BC): 13.65] [MRI OP (%BC): 13.65] [Positron Emission Tomography (%BC): 13.65] [Radiology (%BC): 13.65] [Laboratory (%BC): 55.70] [Occupational Therapy (%BC): 55.70] [Physical Therapy (%BC): 55.70] [Respiratory Services/Therapy  (%BC): 55.70] [Speech Therapy (%BC): 55.70] [Other Outpatient Implant (%BC): 16.69] [IV Therapy (%BC): 55.70] [All Other OP (%BC): 55.70]","count":"1 through 10","median_amount":1127.39,"10th_percentile":858.6,"90th_percentile":1603.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.33,"count":"1 through 10","median_amount":1031.27,"10th_percentile":879.0,"90th_percentile":1537.89},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":411.71,"10th_percentile":411.71,"90th_percentile":411.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Ambetter Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"1 through 10","median_amount":2390.04,"10th_percentile":2390.04,"90th_percentile":2390.04},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":6.93,"10th_percentile":6.93,"90th_percentile":6.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":66.64,"count":"1 through 10","median_amount":10991.58,"10th_percentile":10991.58,"90th_percentile":10991.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":222.56,"10th_percentile":222.56,"90th_percentile":222.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.5,"count":"1 through 10","median_amount":1156.42,"10th_percentile":626.06,"90th_percentile":1904.52},{"payer_name":"Wellpoint","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.8] [Cardiac Cath (%BC): 71.8] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 71.8] [Occupational Therapy (%BC): 71.8] [Physical Therapy (%BC): 71.8] [Respiratory Services/Therapy  (%BC): 71.8] [Speech Therapy (%BC): 71.8] [All Other OP (%BC): 71.8]","count":"1 through 10","median_amount":341.38,"10th_percentile":341.38,"90th_percentile":341.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.22] [Cardiac Cath (%BC): 49.22] [Lithotripsy (%BC): 49.22] [PTCA (%BC): 49.22] [Observation (%BC): 58.33] [Emergency Department (%BC): 58.33] [Other Cardiac Testing (%BC): 55.70] [EEG (%BC): 55.70] [Chemotherapy (%BC): 55.70] [Nuclear Medicine (%BC): 13.65] [Radiation Therapy  (%BC): 55.70] [CT OP Scan (%BC): 13.65] [MRI OP (%BC): 13.65] [Positron Emission Tomography (%BC): 13.65] [Radiology (%BC): 13.65] [Laboratory (%BC): 55.70] [Occupational Therapy (%BC): 55.70] [Physical Therapy (%BC): 55.70] [Respiratory Services/Therapy  (%BC): 55.70] [Speech Therapy (%BC): 55.70] [Other Outpatient Implant (%BC): 16.69] [IV Therapy (%BC): 55.70] [All Other OP (%BC): 55.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.33,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Ambetter Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":66.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellpoint","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"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":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.8] [Cardiac Cath (%BC): 71.8] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 71.8] [Occupational Therapy (%BC): 71.8] [Physical Therapy (%BC): 71.8] [Respiratory Services/Therapy  (%BC): 71.8] [Speech Therapy (%BC): 71.8] [All Other OP (%BC): 71.8]","count":"1 through 10","median_amount":316.85,"10th_percentile":316.85,"90th_percentile":316.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.22] [Cardiac Cath (%BC): 49.22] [Lithotripsy (%BC): 49.22] [PTCA (%BC): 49.22] [Observation (%BC): 58.33] [Emergency Department (%BC): 58.33] [Other Cardiac Testing (%BC): 55.70] [EEG (%BC): 55.70] [Chemotherapy (%BC): 55.70] [Nuclear Medicine (%BC): 13.65] [Radiation Therapy  (%BC): 55.70] [CT OP Scan (%BC): 13.65] [MRI OP (%BC): 13.65] [Positron Emission Tomography (%BC): 13.65] [Radiology (%BC): 13.65] [Laboratory (%BC): 55.70] [Occupational Therapy (%BC): 55.70] [Physical Therapy (%BC): 55.70] [Respiratory Services/Therapy  (%BC): 55.70] [Speech Therapy (%BC): 55.70] [Other Outpatient Implant (%BC): 16.69] [IV Therapy (%BC): 55.70] [All Other OP (%BC): 55.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.33,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Ambetter Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":66.64,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellpoint","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.8] [Cardiac Cath (%BC): 71.8] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 71.8] [Occupational Therapy (%BC): 71.8] [Physical Therapy (%BC): 71.8] [Respiratory Services/Therapy  (%BC): 71.8] [Speech Therapy (%BC): 71.8] [All Other OP (%BC): 71.8]","count":"44","median_amount":223.09,"10th_percentile":71.08,"90th_percentile":530.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.4,"count":"17","median_amount":92.86,"10th_percentile":18.6,"90th_percentile":281.06},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.22] [Cardiac Cath (%BC): 49.22] [Lithotripsy (%BC): 49.22] [PTCA (%BC): 49.22] [Observation (%BC): 58.33] [Emergency Department (%BC): 58.33] [Other Cardiac Testing (%BC): 55.70] [EEG (%BC): 55.70] [Chemotherapy (%BC): 55.70] [Nuclear Medicine (%BC): 13.65] [Radiation Therapy  (%BC): 55.70] [CT OP Scan (%BC): 13.65] [MRI OP (%BC): 13.65] [Positron Emission Tomography (%BC): 13.65] [Radiology (%BC): 13.65] [Laboratory (%BC): 55.70] [Occupational Therapy (%BC): 55.70] [Physical Therapy (%BC): 55.70] [Respiratory Services/Therapy  (%BC): 55.70] [Speech Therapy (%BC): 55.70] [Other Outpatient Implant (%BC): 16.69] [IV Therapy (%BC): 55.70] [All Other OP (%BC): 55.70]","count":"22","median_amount":453.28,"10th_percentile":197.02,"90th_percentile":1079.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.33,"count":"13","median_amount":114.26,"10th_percentile":22.4,"90th_percentile":197.37},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.2,"count":"1 through 10","median_amount":689.22,"10th_percentile":160.69,"90th_percentile":1646.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":33.68,"10th_percentile":4.79,"90th_percentile":416.46,"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":"Sunshine Health","plan_name":"Ambetter Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"1 through 10","median_amount":347.91,"10th_percentile":291.16,"90th_percentile":438.01},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"67","median_amount":22.61,"10th_percentile":8.4,"90th_percentile":65.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":66.64,"count":"19","median_amount":919.24,"10th_percentile":414.66,"90th_percentile":1590.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"14","median_amount":26.38,"10th_percentile":6.3,"90th_percentile":143.13,"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":"percent of total billed charges","standard_charge_percentage":10.5,"count":"161","median_amount":115.52,"10th_percentile":12.79,"90th_percentile":302.71},{"payer_name":"Wellpoint","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.8] [Cardiac Cath (%BC): 71.8] [Observation (%BC): 74.2] [Emergency Department (%BC): 74.2] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 71.8] [Occupational Therapy (%BC): 71.8] [Physical Therapy (%BC): 71.8] [Respiratory Services/Therapy  (%BC): 71.8] [Speech Therapy (%BC): 71.8] [All Other OP (%BC): 71.8]","count":"1 through 10","median_amount":138.48,"10th_percentile":97.08,"90th_percentile":229.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.4,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Health Options Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.22] [Cardiac Cath (%BC): 49.22] [Lithotripsy (%BC): 49.22] [PTCA (%BC): 49.22] [Observation (%BC): 58.33] [Emergency Department (%BC): 58.33] [Other Cardiac Testing (%BC): 55.70] [EEG (%BC): 55.70] [Chemotherapy (%BC): 55.70] [Nuclear Medicine (%BC): 13.65] [Radiation Therapy  (%BC): 55.70] [CT OP Scan (%BC): 13.65] [MRI OP (%BC): 13.65] [Positron Emission Tomography (%BC): 13.65] [Radiology (%BC): 13.65] [Laboratory (%BC): 55.70] [Occupational Therapy (%BC): 55.70] [Physical Therapy (%BC): 55.70] [Respiratory Services/Therapy  (%BC): 55.70] [Speech Therapy (%BC): 55.70] [Other Outpatient Implant (%BC): 16.69] [IV Therapy (%BC): 55.70] [All Other OP (%BC): 55.70]","count":"1 through 10","median_amount":117.39,"10th_percentile":117.39,"90th_percentile":117.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.33,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":76.2,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":11.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages Medicare payment methodology that is excluded from the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). Medicare logic based on reasonable costs.]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Ambetter Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"1 through 10","median_amount":180.97,"10th_percentile":180.97,"90th_percentile":180.97},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":47.02,"10th_percentile":47.02,"90th_percentile":47.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":66.64,"count":"1 through 10","median_amount":281.61,"10th_percentile":281.61,"90th_percentile":281.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"percent of total billed charges","standard_charge_percentage":10.5,"count":"1 through 10","median_amount":122.85,"10th_percentile":4.33,"90th_percentile":122.86},{"payer_name":"Wellpoint","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":22.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]}]}